Percutaneous Internal Ring Suturing Technique Research Articles

Comparison of the results of open repair and laparoscopic repair with the PIRS method in the treatment of hydrocele in children.

Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center. We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed. The data of 113 patients (OR 58.4% (n = 66), LR 41.6% (n = 47)) were collected. In preoperative examination, 12.4% (n = 14) patients were diagnosed as communicating and 87.6% (n = 99) non-communicating hydrocele. Intraoperatively, 65.5% (n = 74) patients were communicating and 34.5% (n = 39) were non-communicating. Total recurrence rate was 7% (n = 8). The OR group experienced a recurrence rate of 10.6% (n = 7), while the LR group experienced 2.12% (n = 1). Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.

Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.

Is Laryngeal Mask a Good Alternative in Children Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing Under and Over Two Years Old?

This study aimed to evaluate respiratory parameters during percutaneous internal ring suturing (PIRS) for inguinal hernia repair in two different-aged pediatric patients in whom the airway is provided with a laryngeal mask or endotracheal tube for general anaesthesia. After local ethics committee and parental consent, 180 ASAI-II children were randomly allocated to 4 groups; according to their age (0-24 months / 25-144 months) and airway device laryngeal mask (LMA) / endotracheal tube (ETT) used for general anaesthesia (45 children each) for laparoscopic inguinal hernia repair. Standard anaesthesia induction was done with lidocaine, propofol, and fentanyl, and 0.6 mg kg-1 rocuronium was added to the ETT groups. Sevoflurane is used for maintenance. Hemodynamic parameters, peak airway pressure, end-tidal carbon dioxide (EtCO2), and peripheric oxygen saturation (SpO2) values were recorded after induction, before, and during pneumoperitoneum. The duration of anaesthesia, surgery, recovery time, and surgical satisfaction was recorded. Airway complications (cough, laryngospasm, bronchospasm, desaturation, and aspiration) were recorded. Hundred and eighty patients (45 in each group) were analyzed. Duration of surgery and surgical satisfaction were similar in all groups. Duration of anaesthesia and recovery times were significantly shorter in the LMA groups. Peak airway pressure and EtCO2 levels were significantly lower in the LMA groups. Rare airway complications were observed without significance. In laparoscopic inguinal hernia repair with the PIRS technique, LMA offered comparable operating conditions and surgical satisfaction.

Percutaneous Internal Ring Suturing for the Minimally Invasive Repair of Congenital Inguinal Hernia in Neonates: A Retrospective Cohort Study.

Introduction Inguinal hernia (IH) repair is among the most frequently performed surgical operations in children. While open herniorrhaphy has been the gold standard surgical method of choice, the popularity of laparoscopic repair has sharply risen over the past two decades. Although a wide range of literature on the use of laparoscopy for IH repair in children exists, data regarding neonates, an especially delicate group of children, is limited to only a few studies. This study aims to evaluate the surgical, anaesthetic, and follow-up data of term neonates undergoing percutaneous internal ring suturing (PIRS) for IH repair in order to determine if it is a viable option for this specific patient population. Materials and methods This single-centre retrospective cohort included all children who underwent PIRS for IH repair during an 86-month period betweenOctober 2015 and December 2022. Patients' gender, gestational age at birth, age and weight at surgery, side of IH at diagnosis, per-operative findings (presence of contralateral patent processus vaginalis (CPPV)), surgical time, time under anaesthesia, follow-up time, and follow-up findings were collected from an electronic database and analysed.The primary outcome measures were surgical time, rate of recurrence, and presence of CPPV and the secondary outcome measures were anaesthesia time and the rate of complications. Results During the study period, 34 neonates (23 male and 11 female) underwent laparoscopic repair for IH using the PIRS technique. Average age and weight at surgery were 25.2 ± 3.2 (20-30) days and 3530.4 ± 293.6 (3012 - 3952) gm, respectively. IH was detected on the right side in 19 (55.9%), on the left side in 12 (35.3%), and bilaterally in three (8.8%) patients at their presenting physical examination. Nine patients (26.5%) were found to have CPPV perioperatively, which were all repaired simultaneously. The average surgical time was 20.3 ± 4.5 minutes for unilateral and 25.8 ± 4.0 minutes for bilateral IH repair (p<0.01). On the contrary, the average time under anaesthesia was 33.2 ± 4.5 minutes for unilateral and 33.5 ± 4.9 minutes for bilateral IH repair, but the difference was not statistically significant (p>0.05). No early postoperative complications were observed. The average follow-up time was 27.6 ± 14.4 (range: 3-49) months. Recurrence was seen in one patient (2.9%) andumbilical incision granuloma was observed in two (5.9%) patients. Conclusion Surgical times, anaesthesia times, complication rates, recurrence rates, and rate of CPPV in neonates undergoing PIRS are similar to those in older children and comparable to those of open herniorrhaphy and other laparoscopic techniques. Despite the suspicion that the rate of CPPV would be higher in neonates, we found that it is similar to that in older children. We conclude that PIRS is a viable option for the minimally invasive repair of IH in neonates.

Inguinal Hernia Repair with Laparoscopic-Supported Percutaneous Internal Ring Suturing Technique in Children - One Center Experience

Objective: High ligation of the hernia sac is applied as the basic principle in inguinal hernia surgery. Nowadays, it is possible to perform inguinal hernia surgeries with minimally invasive methods and with the help of technological developments with the same success rates. One of these minimally invasive methods is the percutaneous internal ring suturing method, assisted by laparoscopy. In this study, we aimed to present the case series that we treated with a laparoscopy-assisted percutaneous internal ring suturing and its results up to six months after surgery. Material and Methods: Pediatric patients admitted to the Pediatric Surgery Clinic of Our Hospital with indirect inguinal hernia between November 01, 2019, and February 29, 2020, were included in the study. Patients with clinical features of incarcerated inguinal hernia were excluded from the study. Inguinal hernia repair was performed by the percutaneous internal ring suturing method supported by laparoscopy. Results: During the study period, 36 inguinal hernia repairs were performed in 27 patients. The distribution of age groups is over 24 months (8/27), 2-6 months (5/27), 6-12 months (4/27), and 12-24 months (1/27). No patient required open surgical technique or the use of additional trocars. The mean operation time was 24.3±1.77 minutes. The mean hospitalization period of the patients was 2.15±0.12 days. During the follow-up of the patients, no recurrence, intra-abdominal complication, or inguinal complication was detected. Conclusion: We found that the percutaneous internal ring closure method applied under laparoscopic support in childhood is an easy and safe method for indirect inguinal hernia repair.

Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing.

Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

Comparison of Open Repair and Laparoscopic Percutaneous Internal Ring Suturing Method in Repairing Inguinal Hernia in Children.

IntroductionAn inguinal indirect hernia is one of the most frequent surgical conditions in children. In this study the experience with laparoscopic percutaneous internal ring suturing (PIRS) and open inguinal hernia surgery and their relations evaluated.MethodsAll children over 90 days of age and without having prior inguinal region surgery with a diagnosis of indirect inguinal hernia underwent surgical repair with open or laparoscopic PIRS technique. Patients' gender, age at surgery, inguinal hernias side, surgery duration, recurrence, complications, and follow-ups were collected.ResultsA total of 488 inguinal hernias of 405 patients were repaired. The diagnoses were unilateral inguinal hernia in 360 (88.9%) and it was bilateral in 33 (8.1%) patients. The operative technique was laparoscopic PIRS for 227 and open inguinal hernia surgery for 178 patients. In the PIRS group, a contralateral hernia was found in 48 of 205 children (23.4%). The surgery times were 23.3 (PIRS) and 33.7 (open) min for unilateral and 28 (PIRS) and 53.1 (open) min on average for bilateral inguinal hernia surgery. Mean follow-up was 30.4 months for PIRS and 24.4 months for open technique. Recurrence was observed in seven (3%) patients in PIRS and one (0.5%) in the open group and postoperative complications in three (1.3%) in PIRS and four (2.2%) in the open group.ConclusionPIRS method has the advantage to evaluate contralateral hernia at the same session, minimal scar related to surgery, and preserve the spermatic cord from manipulation. PIRS is an alternative feasible method and easy to perform to repair the inguinal hernia with/without communicating hydrocele in children.

A single institution experience with Laparoscopic Hernia repair in 791 children

IntroductionThere are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique. MethodsA retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p < 0.05 was considered significant during the analysis. Results791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21 min (IQR 16, 28), while the median time for a bilateral repair was 30.5 min (IQR 23, 41).In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two were re-repaired laparoscopically. ConclusionsThe use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.

Laparoscopic percutaneous internal ring suturing for paediatric inguinal hernias: a South African tertiary centre experience

ABSTRACT BACKGROUND: Laparoscopic inguinal hernia repair is routine in many paediatric centres. One of several techniques described in 2006 is the laparoscopic percutaneous internal ring suturing (PIRS) technique. This technique which is not widely used in South Africa has been adopted for paediatric inguinal hernias at our institution, and this is a review of the experience METHOD: The study is a retrospective review of the patients who underwent PIRS (a single port combined percutaneous procedure used to close the internal ring) at our hospital from October 2018 until March 2020. We describe the technique in our setting and review our cohort of patients, demographics, clinical presentation, operative duration and complications RESULTS: One hundred and ten laparoscopic PIRS procedures were performed on 94 patients; 15 had bilateral inguinal hernias. Polydioxanone and Prolene were the sutures used for the procedures. Average operative time was 12 minutes for unilateral hernias and 33 minutes for bilateral hernias. All operations were completed laparoscopically. Follow-up was for a minimum of three months, but up to 21 months. Complications included three intraoperative haematomas, three hydrocoeles and two umbilical granulomas postoperatively. There were two recurrent hernias of which one was managed with redo PIRS; the other required open herniotomy for an irreducible obstructed hernia CONCLUSION: This review is supportive evidence that the PIRS technique for managing paediatric inguinal hernias in a tertiary institution in South Africa can be performed safely with few complications Supplementary video available online: http://sajs.redbricklibrary.com/index.php/sajs/article/view/3498 Keywords: inguinal hernia, paediatric, laparoscopy, percutaneous internal ring suturing

The application of the percutaneous suturing technique in thoracoscopic repair of congenital diaphragmatic hernia.

Thoracoscopic surgery of congenital diaphragmatic hernia (CDH) is connected with a higher incidence of recurrence than open repair is. This is usually caused by the dehiscence of sutures in the lateral part of the defect. This area is characterized by increased tension on proximate tissues and difficult thoracoscopic suturing. For more effective repair, the authors adopted a variant of percutaneous internal ring suturing (PIRS) technique. To present and evaluate the efficacy of the PIRS technique for the repair of CDH. The study is based on retrospective analysis of the medical data of patients with CDH treated in the Department of Pediatric Surgery of the Jagiellonian University Medical College (Kraków, Poland) from January 2013 to July 2019. The PIRS technique was applied when thoracoscopic repair under acceptable tension appeared impossible. Fifty-one patients were identified. Of these, 11 children died before surgery and 1 after, leaving 39 (76%) who were operated on and survived. Thoracoscopy was used in 27 cases (69%), with 3 conversions. The recurrence rate in patients who underwent thoracoscopic closure of the defect with intermittent sutures was 27% (3 out of 11 children), while in the group that underwent thoracoscopic repair with the additional use of percutaneous suturing, the recurrence rate was 6.25% (1 out of 16 patients). The follow-up periods ranged from 4 months to 6 years. The applied PIRS technique permits safe and effective closure of intermediate-size diaphragmatic defects under acceptable tension. The method is feasible and can be listed among countermeasures against recurrence.

Laparoscopic inguinal hernia repair in children via PIRS (percutaneous internal ring suturing).

The miniinvasive approach is atrend in pediatric surgery nowadays. The new surgical technique called percutaneous internal ring suturing (PIRS) is apromising method bringing all the benefits of miniinvasive surgery. Prospective study of patients operated on using the PIRS technique from 01 January 2018 to 01 January 2020 at the Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University, University Hospital Motol. 73 patients (25 boys and 48 girls) were operated on using PIRS. The median age was 68 months. 90% of operations were performed by the same team of surgeons. During the procedure there were found 53 right-sided and 38 left-sided inguinal hernias. In 18 cases the hernia was bilateral, but only in 13 cases was this diagnosis made before the operation. Anon-absorbable stitch was used in 57 cases to close the internal ring of the inguinal canal, and anon-absorbable monofilament in 16. The median operating time was 34 minutes. There were 3 recurrences (3.3%) in our study. Conclusion: In our initial study, the PIRS technique proved to be asafe alternative method to the open inguinal hernia surgery. This method provides the benefit of allowing to revise the contralateral inguinal canal as aprevention of ametachronous inguinal hernia. The cosmetic results were excellent.

Initial Experience with Percutaneous Internal Ring Suturing for Indirect Inguinal Hernia in Pediatric Patients.

PurposeThe aim of this study is to review our experience in treating indirect inguinal hernia in pediatric patients.MethodsWe retrospectively studied a total of 43 patients who underwent percutaneous internal ring suturing (PIRS) for indirect inguinal hernia from January 2016 to September 2018. The participants included 29 boys and 14 girls. There were cases of bilateral internal inguinal hernia (n=12), right indirect inguinal hernia (n=16), and left indirect inguinal hernia (n=15). Their mean age was 3.8±2.9 years, and mean body weight was 16 kg. Clinical features and surgical outcomes were analyzed.ResultsMean operating time was 35 min for unilateral inguinal hernia and 40 min for bilateral inguinal hernia. There were five cases of intraoperative bleeding (12%) during needle insertion. In two cases, stress test resulted in escape of gas into the hernial sac and a second suture was inserted. The contralateral patent processus vaginalis was present in six (14% of cases) and closed. Follow-up was 6~30 months. Mean postoperative hospital stay was 1.2 days. No recurrence hernia and postoperative complications were reported.ConclusionAlthough this study investigated a small number of cases and the surgical experience was rather limited, the PIRS technique was shown to have advantages such as a short learning curve and its aid in detecting contralateral hernias. In this study, there were no reports of recurrence, metachronous inguinal hernias, and postoperative complications.

Laparoscopic inguinal hernia repair in girls using the percutaneous internal ring suturing technique – our own experience

Objective We evaluate d the usefulness of the percutaneous internal ring suturing (PIRS) technique in girls only. Background PIRS is a percutaneous closure of the internal inguinal ring under the control of a telescope/laparoscope placed through the umbilicus. Material and methods Thirty girls underwent surgery using this method in our institution between 2016 and 2017. We used telescope (3 mm, 0°), spinal needle (20 G), and nonabsorbable polypropylene 3-0 suture. The insufflation pressure in the peritoneal cavity was maintained at 8–10 mmHg. Results We selected the isolated cases of the inguinal hernia in only girls. There was no need of conversion to open surgery in our study. The recurrence was seen in two (6.6%) cases. These were treated by open herniotomy. We did follow-up with local clinical examination only. Conclusion PIRS technique is an alternative for the open inguinal surgery. It is effective and minimally invasive surgery and without visible scar. It is also useful to detect the other abnormalities and can perform other procedure in same session such as contralateral inguinal hernia and umbilical hernia.

Çocuklarda kasık fıtığı onarımında açık teknik ve perkütan internal ring sütürizasyon tekniğinin karşılaştırılması

Objective: Laparoscopic inguinal hernia surgery has recently been a preferred surgical approach among pediatric surgeons. The aim of this study is to compare open and laparoscopic inguinal hernia repair techniques in terms of complications and recurrences in children. Method: Patients whose inguinal hernias were operated with laparoscopic percutaneous internal ring suturing technique and open high ligation technique were included in the study. Dermographic data, surgical details and postoperative complications of the patients were reviewed retrospectively. Results: A total of 246 patients were included in the study. Among them 113 patients underwent laparoscopic inguinal hernia repair and 133 patients open inguinal hernia repair. The mean age of patients in the laparoscopic group was 27.7 months (1-192 months) and the mean age of patients in the open surgery group was 27.5 months (1-156 months). Diagnostic laparoscopy was performed in 104 patients who underwent open surgery, and the contralateral inguinal hernia repair was performed in 33 of the patients after hernia was detected on the contralateral side. Recurrence was observed in 2.6% (n=3) of the patients who underwent laparoscopic surgery and 3.7%(n=5) of the patients undergoing open surgery. In 2 of the patients who underwent laparos- copic surgery had hematomas that resolved without intervention and 1 had hydrocele. On the other hand 4 of the patients who underwent open surgery had iatrogenic undescended testis and 1 had hydrocele. The follow-up periods of the patients who underwent laparoscopic or open surgery were 13.2, and 74 months, respectively. Conclusion: Laparoscopic inguinal hernia repair has results comparable to open repair in terms of recurrence and complications. The advantage of the laparoscopic method can be considered as the ability to evaluate the contralateral side in all cases without increase in the risk of recur- rence and complications, and the ability to operate without scarring , but with good cosmetic results.

Inguinal hernia containing uterus in a newborn: What to do?

A preterm newborn of 31 weeks of gestation was admitted because of hyaline membrane disease and apnea-bradycardia syndrome. On day 3 of life, a left inguinal hernia was detected, but was not painful and reducible. Sonographically, a homogeneous and hypoechoic mass containing a hyperecoic line was observed in the hernia sac, corresponding to a uterus with the endometrium. Besides the uterus, one of the ovaries could be seen. Color Doppler ultrasonography revealed no vascular compromise (Figure 1, Figure 2).Figure 2Inguinal hernia (circle) with left ovary and fallopian tube (white arrow) and part of the body and uterine fundus (spotted arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Surgery was deferred until the patient was 2-months-old. We used the percutaneous internal ring suturing (PIRS) technique. During surgery, an internal left ring was found open with herniation of the ovary, left fallopian tube, and part of the uterus. The patient's recovery after surgery was satisfactory, and she was discharged in 48 h with no complications. After two years of follow-up, no recurrence or complication was observed. Inguinal hernia is very frequent in the pediatric population.1Laing F.C. Townsend B.A. Rodriguez J.R. Ovary-containing hernia in a premature infant: sonographic diagnosis.J Ultrasound Med. 2007; 26: 985-987Crossref PubMed Scopus (30) Google Scholar, 2Kaya O. Esen K. Gulek B. Yilmaz C. Soker G. Onem O. The inguinal herniation of the ovary in the newborn: ultrasound and color Doppler ultrasound findings.Case Rep Radiol. 2014; 2014: 281280Google Scholar The cause is due to incomplete closure of the processus vaginalis of the peritoneum, which usually closes by the 8th month of pregnancy. Up to 20% of hernias can contain the ovaries or even the fallopian tubes.3Akıllıoğlu I. Kaymakcı A. Akkoyun I. Güven S. Yücesan Ş.. Hiçsönmez A. Inguinal hernias containing the uterus: a case series of 7 female children.J Pediatr Surg. 2013; 48: 2157-2159Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The presence of the uterus inside the hernia sac (“hernia uterus inguinale”) with the uterine adnexa is an exceptional condition in infants.3Akıllıoğlu I. Kaymakcı A. Akkoyun I. Güven S. Yücesan Ş.. Hiçsönmez A. Inguinal hernias containing the uterus: a case series of 7 female children.J Pediatr Surg. 2013; 48: 2157-2159Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar In these cases, the spontaneous reduction is less frequent, and the risk of incarceration is higher than in others. There is controversy about both the timing to perform the surgery and what surgical technique to use. Some authors defend deferred surgery if there is no vascular compromise; whereas others, recommend urgent surgery regardless of the status.3Akıllıoğlu I. Kaymakcı A. Akkoyun I. Güven S. Yücesan Ş.. Hiçsönmez A. Inguinal hernias containing the uterus: a case series of 7 female children.J Pediatr Surg. 2013; 48: 2157-2159Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Given that there was no vascular compromise, we decided to defer surgery with the approval of the Hospital Ethics Committee and had a satisfactory outcome. The PIRS technique allows a better view of the pelvic organs and enables safe closure of the internal ring ensuring that both the uterus and the adnexa are correctly placed in the peritoneal cavity. Also, it is very beneficial to explore the contralateral inguinal canal and close it if necessary. The authors have no conflicts of interest relevant to this article. The following is the Supplementary data to this article: Download .docx (.01 MB) Help with docx files Multimedia component 1

Effects of Laparoscopic Hernia Repair by PIRS (Percutan Internal Ring Suturing) Technique on Testicular Artery Blood Supply

ABSTRACTPurpose: Percutaneous internal ring suturing technique (PIRS) is a minimally invasive technique in pediatric inguinal hernia repair. In the present study, a negative effect on testicular blood flow using PIRS technique has been investigated. Methods: Forty male patients were included in the study prospectively. Two groups were formed as conventional open surgery (Group I) and PIRS technique (Group II). The resistive index (RI) value of the testicular artery was measured prospectively by using SMI (superb micro-vascular imaging) software with the color doppler ultrasound technique preoperatively and postoperatively at the first month. Results: Inguinal hernia was present on the left in 35% (n = 14) of the patients and on the right in 65% (n = 26) of the patients. There was no statistically significant difference (p = 0.727) between Group I and II with regard to preoperative RI value (0.66 ± 0.07 vs. 0.66 ± 0.45, respectively). Similarly, there was no statistically significant difference (p = 0.220) between Group I and II with regard to the RI values measured at the postoperative first month (0.58 ± 0.04 vs. 0.60 ± 0.04, respectively). Although the postoperative RI values decreased compared to the preoperative values in both groups, this difference was not statistically significant. (p = 0.447 in Group I, and p = 0.175 in Group II for intragroup comparison). Conclusions: Besides PIRS technique has the advantages provided by all other laparoscopic techniques defined for inguinal hernia repair, there is no significant difference between this technique and conventional open surgery with regard to testicular blood flow. It is an innovative candidate technique instead of the open surgery method besides its additional advantages.

One trocar needlescopic assisted inguinal hernia repair in children: a novel technique

BackgroundInguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children. Patients and methodsThree-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results. ResultsThis prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6±1.3years (range=4months to 6years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6±1.7min (range=8–15min) for unilateral cases and 18.6±1.7min (range=14–20min) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6±1.2months (range=11–36months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible. ConclusionThis preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery. The procedure is very safe, rapid, easy to learn, and reproducible.

Percutaneous internal ring suturing as a first choice laparoscopic inguinal hernia repair method in girls: a single-center study in 148 patients.

We sought to retrospectively assess the operative findings and clinical outcomes of 148 girls who underwent laparoscopic inguinal hernia repair with the percutaneous internal ring suturing (PIRS) technique. Between 2010 and 2014, girls with inguinal hernia underwent surgery using the laparoscopic PIRS technique described by Patkowski. Demographic and perioperative findings, complications, and recurrences were evaluated. A total of 205 inguinal hernia repairs were performed in 148 children with a mean age of 5.83years (1month-16years). In 57 girls (38.5%), the hernias were bilaterally repaired, while in 91 girls (61.5%) hernias were unilaterally repaired. The mean follow-up time was 3.6years (range 2.5-6.1years). No serious complications or recurrence were noted. Granuloma occurred in one patient. The PIRS technique is a safe, simple and effective procedure for girls. Excellent cosmetic results and reduced recurrence rates are associated with this method. This procedure is particularly suitable for girls because they lack a spermatic cord and vascular structures that can cause complications with this technique in boys. Based on our experience and others in the literature, we suggest that the PIRS procedure might be considered a gold standard for inguinal hernia operations in girls.

Does the Percutaneous Internal Ring Suturing Technique Impair Testicular Vascularization in Children Undergoing Inguinal Hernia Repair?

The aim of this study was to evaluate the effect of the percutaneous internal ring suturing (PIRS) technique on testicular vascularization when used for inguinal hernia repair in children. In this prospective study, 49 boys older than 1 year who had been diagnosed with unilateral inguinal hernia were evaluated. Hernias were repaired using the laparoscopic PIRS technique. The testes of each patient were examined using Doppler ultrasound at the preoperative, early postoperative, and late postoperative periods. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI) of the intratesticular centripetal and testicular capsular arteries were determined. PSV, EDV, and RI of the centripetal and capsular arteries were similar between preoperative, early postoperative, and late postoperative periods, with no statistically significant differences detected. Testicular vascularization was not affected by hernia repair using the PIRS technique in our study. We therefore conclude that PIRS is a safe technique for inguinal hernia repair with respect to testicular vascularization.

Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience.

IntroductionPercutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus.AimTo evaluate the usefulness of the PIRS technique.Material and methodsFifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010.ResultsIn 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery.ConclusionsInguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery).