Pediatric Indirect Inguinal Hernia Research Articles

Percutaneous Internal Ring Suturing A minimally invasive procedure in pediatric inguinal hernia repair

Percutaneous internal ring suturing (PIRS) is a single-port laparoscopic technique to repair a pediatric indirect inguinal hernia. We used PIRS in our babies and found that the surgery time was shortened, with smaller incisions, lesser complications, and early discharges. This is a retrospective case study to introduce our novel minimally invasive method of repairing pediatric hernias with fewer complications, safe and cost-effective.

Percutaneous Internal Ring Suturing (Pirs): A Minimally Invasive Procedure in Pediatric Inguinal Hernia Repair

Objective Percutaneous internal ring suturing (PIRS) is a single port laparoscopic technique used to repair pediatric indirect inguinal hernia. Unlike the open method, which is the gold standard of the hernia repair, this technique is still new in the fraternity and not many centers practiced it. We applied this technique on our patients and we found that the duration of surgery was shortened, smaller surgical incision, lesser complications and early discharges. Methods Patient selection was done based on several criteria, term baby with no anomalies, indirect inguinal hernia, and male baby with a thin abdominal wall. The baby was put under general anesthesia via endotracheal intubation. One-centimeter infraumbilical incision was made and a 3mm 70◦ scope is inserted after a pneumoperitoneum achieved. With the guidance of the scope, a spinal needle with a Prolene 2-0 was punctured and threaded in on the medial edge of the internal inguinal ring (Figure 1-3). Once the sutures in, the needle is withdrawn. Similarly, another Prolene 2-0 is punctured and threaded in on the lateral edge of the internal inguinal ring (Figure 4). This time, the needle is looped into the first suture (Figure 5). After the withdrawal of the needle, the sutures were tightened and ligated (Figure 6). Laparoscopy is used to inspect that the internal ring is snugly closed without the entrapment of the vas or the cord structures. Once ligated, the scope is removed and the port site is sutured using a purse-string suture. The patient is extubated, observed in the general ward till afternoon and was discharged home after passing flatus, stool, and urine.

A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China

BackgroundPediatric inguinal hernia (PIH) is a common disease in children. Laparoscopic hernia repair (LHR) has developed rapidly in recent years, but there are still different opinions compared with traditional open hernia repair (OHR). The purpose of this study was to compare the advantages and disadvantages of LHR and OHR in the treatment of pediatric inguinal hernia.MethodsWe performed a retrospective review of all children (< 14 years) who underwent repair of inguinal hernia in the pediatric surgery center of the Affiliated Hospital of Qingdao University from January 2015 to December 2015. We collected the medical records of all the children and analyzed the clinical characteristics, operation-related information and follow-up.ResultsIn the OHR group, 202 cases underwent unilateral inguinal hernia repair, and 43 cases underwent bilateral inguinal hernia repair. In the LHR group, 168 cases underwent unilateral inguinal hernia repair, and 136 cases underwent bilateral inguinal hernia repair. There was a significant difference in the operation time between the two groups, but there were no significant differences in postoperative hospitalization time and incidence of ipsilateral recurrent hernia between the two groups. The incidence rates of metachronous contralateral hernia (MCH) and surgical site infection in LHR group were significantly lower than those in the OHR group.ConclusionOur study shows that compared with OHR, LHR has the advantages of concealed incision, minimal invasiveness, reduced operation time, detection of contralateral patent processus vaginalis, and reduced incidence of MCH. In conclusion, LHR is safe and effective in the treatment of pediatric indirect inguinal hernia.

Development and current status of treatment for pediatric indirect inguinal hernia

To investigate the development and current status of the treatment of pediatric indirect inguinal hernia. Inguinal hernias include indirect hernias and direct inguinal hernias, but there are almost indirect inguinal hernias in children . Pediatric indirect inguinal hernia that the most common disease in pediatric surgery is almost caused by patent processus vaginali which incidence ranges from 0.8% to 4.4%.The treatment of pediatric indirect inguinal hernia reflects the process of pediatric surgery development, which from conservative non-surgical treatment to high ligation of the longitudinal incision hernia sac. In recent years, with the continuous improvement of medical level in China, laparoscopic technique has been applied in hospitals all over China, and laparoscopic high ligation of indirect inguinal hernia sac has become the standard for the treatment of pediatric indirect inguinal hernia.

The study of totally transumbilical single-port laparoscopic herniorrhaphy and traditional surgery in treat-ment with pediatric indirect inguinal hernia

Objective To compare the effect and safety of totally transumbilical single-port laparoscopic herniorrhaphy and traditional surgery in treatment with pediatric indirect inguinal hernia. Methods 100 children with indirect inguinal hernia were divided into control group(n＝50)and observation group(n＝50). The control group was given to traditional surgery. The observation group was given to totally transumbilical single-port laparoscopic herniorrhaphy. The operation related index, postoperative complications and hernia recurrence rate were compared between the two groups. Results The intraoperatve bleeding, incision length, operation time and hospital stays of the observation group respectively were(18.1±5.9)mL,(1.3±0.3)cm,(27.4±7.9)min and(4.5±1.2)d,those of the control group respectively were(38.7±8.1)mL,(2.2±0.4)cm,(46.7±9.2)min and(7.4±1.3)d,the difference was statistically significant(t＝3.439,3.811,2.872,2.878,P＝0.026,0.019,0.045,0.049).The postoperative complications rate of observation the group and the control group were respectively 8.0%(4／50)and 24.0%(12／50),the difference was statistically significant(χ2＝4.762,P＝0.029). Postoperative follow-up of 1 year,the hernia recurrence rate of the observation group and the control group respectively was 0(0／50)and 12% (6／50),the difference was statistically significant(χ2＝6.383,P＝0.012). Conclusion Using totally transumbili-cal single-port laparoscopic herniorrhaphy treat with pediatric indirect inguinal hernia is safe and effective. It is ben-eficial to prevent recurrence, and is worth clinical promotion. Key words: Hernia; Inguen; Laparoscope; Child; Single-port

A human case study demonstrating the safety and effectiveness of laparoscopic surgical glue injection hernioplasty for pediatric indirect inguinal hernia

The purpose of this pediatric case report was to provide clinical evidence supporting the safety and effectiveness of laparoscopic surgical glue injection hernioplasty (LSGIH) in humans for indirect inguinal hernia repair. We performed LSGIH on a female newborn for a right indirect inguinal hernia that was incidentally discovered during a laparoscopic right salphingo-oophorectomy for prenatal right ovarian cyst torsion. Under laparoscopic control, the internal ring was closed by injection of Histoacryl into the internal opening of the patent processus vaginalis. One month later, the patient underwent another laparoscopic operation due to torsion of a newly developed contralateral ovarian cyst. During the second operation, we were able to clearly observe the previous LSGIH site. Despite partial absorption of the injected Histoacryl , the opening of the internal ring remained closed without any evidence of adhesions. This case supports LSGIH as a simple, safe, and useful technique for pediatric inguinal hernioplasty. However, more clinical trials should be performed to confirm the long-term reliability and safety of LSGIH in humans.

Laparoscopically assisted repair of inguinal hernia through a micro-incision and extra-peritoneal division and ligation of the hernia sac

High ligation and division of the hernia sac are the two important steps in open pediatric indirect inguinal hernia repair. We describe a laparoscopically assisted method of delivering the hernia sac through a 5-mm micro-incision with complete division and high ligation of the hernia sac similar to the open repair method. A new laparoscopic technique of pediatric inguinal hernia repair which allows high ligation, complete division and removal of the indirect inguinal hernia sac is described. Twenty-six patients (15 boys, 11 girls) underwent laparoscopic inguinal hernia repair. The mean age was 40 months. 13 patients had bilateral inguinal hernia repair. There were no intra-operative complications and at mean follow-up of 6 months, there was 1 recurrence. No other complications (wound infection, suture granuloma formation, hydrocele) were seen post-operatively. This new laparoscopically assisted inguinal hernia repair technique combines the advantages of standard open method and laparoscopy. The efficacy of this repair will need confirmation with a longer follow-up and a larger patient series. The effect of traction on cord structure will need to be monitored.

Inversion Herniotomy: A Laparoscopic Technique for Female Inguinal Hernia Repair

Laparoscopic inversion herniotomy (LIH) is a method of inguinal hernia repair for female patients. In this article, we report our technique and outcomes for this procedure. We propose that LIH is a valid alternative to conventional open herniorraphy. Following institutional review board approval, we reviewed the charts of patients who underwent LIH or open inguinal hernia repair (OIH) from 2004 to 2007. LIH was performed with three instrument sites and no groin incision. The diagnosis, operative time, and complications were reviewed. Follow-up ranged from 5 months to 4 years. We performed 79 LIH repairs (15 bilateral, 23 left, and 26 right) in 63 female children. We also performed 76 contemporaneous OIH repairs in girls. The age range was 1 month to 18 years (median, 3.8 years). Operative times for both the unilateral and bilateral LIH repairs were significantly shorter than those for OIH (P = 0.001). There were 2 recurrences after laparoscopic inguinal hernia repair, both within 5 months following repair early in our experience, compared to no hernia recurrences with OIH. The first recurrence was repaired conventionally via an open technique. The second case was repaired laparoscopically. LIH is an effective method for the repair of pediatric indirect inguinal hernia in female patients. The procedure allows the evaluation of the asymptomatic contralateral side without the necessity of a second long inguinal incision.

The Neglected Inguinal Hernia

The pediatric indirect inguinal hernia is by far the most common anomaly requiring surgical correction. Modern advances in pediatric surgical and anesthetic techniques and the improved preoperative and postoperative care of children have made the elective pediatric herniorrhaphy a remarkably safe procedure. Many centers in this country and abroad are treating the uncomplicated inguinal hernia in infants and children in the outpatient clinic. The safety of this practice is impressive even in the very young.