Pediatric Inguinal Hernia Repair Research Articles

Testicular Vascularization after Pediatric Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

The effect of pediatric inguinal hernia repair (IHR) on testicular vascularization remains unclear. Manipulating the spermatic cord during surgery may reduce blood flow due to edema and vasoconstriction. This can lead to testicular atrophy. The study aims to review current knowledge of testicular vascular impairment following IHR in children. A systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, and Web of Science. Methodological quality was assessed using validated tools. Data were extracted, and a pooled data analysis was performed. Ten studies were included in the systematic review. Six of these studies were eligible for meta-analysis. This revealed a significant decrease in testicular vascularization during the short-term follow-up (1 day-1 week) after IHR using the open surgical approach. This decrease was not present after laparoscopic intervention. There was no more increased resistance in the vessels at long-term follow-up (1 month-6 months), suggesting that the impaired vascularity is only temporary. There seems to be a short-term transient vascular impairment of the testis after open IHR in children. This might be of clinical relevance to prefer the laparoscopic approach for IHR in children, even though the open approach is the gold standard, in contrast to adult IHR. The impact on testicular function and sperm quality later in life remains unclear. Comparative studies of both techniques are needed to determine if there is a significant difference in testicular vascularity. Long-term studies are necessary to assess the impact of transiently reduced vascularity on sperm quality and fertility later in life.

Is the double-ligation method safe and effective in laparoscopic paediatric inguinal hernia repair? A retrospective cohort study.

Laparoscopic paediatric hernia repair has since been performed more frequently. Recently, a double-ligation method was introduced to prevent recurrence in laparoscopic surgery. The objective of our study was to compare the postoperative outcomes of patients who underwent double and single ligations. We performed a retrospective review of patients with inguinal hernia who underwent laparoscopic paediatric inguinal hernia repair from 2014 to 2018 at our institution. Patients were divided into two groups and underwent single ligation and double ligation. Three hundred and six patients (single-ligation group: 142 and double-ligation group: 164) were included. Four patients experienced recurrence, and the recurrence rate was 1.29%. The recurrence rate was significantly higher in the single-ligation group. There were no statistically significant differences in the postoperative complications between the two groups. Double-ligation method in laparoscopic paediatric hernia repair was relatively safe and helpful.

Erector spinae plane block versus caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair: a randomized controlled trial

Background Erector spinae plane block is a promising strategy for pain management in some settings. However, the effectiveness of erector spinae plane block versus caudal block in pediatric inguinal hernia repair has yet to be formally investigated. Methods One hundred and two patients aged 2–5 years undergoing unilateral open inguinal hernia repair randomly received unilateral erector spinae plane block (0.2% ropivacaine 0.5 mL kg−1), caudal block (0.2% ropivacaine 1 mL kg−1), or no block. The primary outcome was time to the first rescue analgesia, defined as the interval from the end of surgery to the Face, Legs, Activity, Cry, and Consolability scale greater than three. Secondary outcomes included the number of patients requiring rescue analgesia, the area under the curve of pain scores over time, satisfaction of guardians, and adverse events. Results The median time to the first rescue analgesia was longer in the erector spinae plane block group than in the caudal block group [10.0 h (interquartile range, 6.6–24.0 h) vs. 5.0 h (interquartile range, 2.9–7.3 h); p < .001]. The Cox regression model demonstrated that the risk of postoperative rescue analgesia requirement was 0.38 in children receiving erector spinae plane block compared with caudal block (95% confidence interval 0.23–0.64; p < .001). Additionally, the area under the curve of the pain scores over time was lower in the erector spinae plane block group than in the caudal block group (44.3 [36.6–50.7] vs. 59.0 [47.1–64.5]; p < .001). Conclusions Erector spinae plane block provided superior postoperative analgesia compared to caudal block in children undergoing inguinal hernia repair. Trial registration: Chinese Clinical Trial Registry; ChiCTR2100048303

Development of an international core outcome set for treatment trials in paediatric inguinal hernia: protocol for a three-phase study including a systematic review and Delphi survey

IntroductionIn children, open inguinal hernia repair has been the gold standard for treatment, but with recent technical advancements in laparoscopy, laparoscopic hernia repair is gaining popularity. Despite available results from...

Addition of Transfixation Suture to Purse String Suture During Intraperitoneal Inguinal Hernia Repair Increases Peri-Hernia Sac Neck Collagen Formation

BackgroundThe worldwide accepted repair for indirect inguinal hernia in children is high ligation of the hernia sac with open herniotomy. However, laparoscopic pediatric inguinal hernia repair (IHR) has been gaining popularity in the last two decades. An experimental study was conducted to investigate the effects of different intraperitoneal IHR suture techniques on the collagen formation at the hernia sac neck. MethodsPresent study was conducted on thirty-five male adult (3–6 months old) Wistar-Albino rats (260–300 g). Intraperitoneal IHR with different hernia sac neck suturing techniques (purse string suture only, transfixation suture only and purse string suture plus transfixation suture) were performed through median laparotomy using open operative techniques. Non-absorbable 2/0 braided polyester suture with 16 mm 1/2 curved round needle (Ti-cron, Covidien, MN) was used as suture material. ResultsThe highest collagen thickness around the suture was detected in intraperitoneal IHR with purse-string plus transfixation suture group. The collagen thickness of the intraperitoneal IHR with purse string suture only and IHR with tranfixation suture only groups were not statistically significantly different. The collagen thickness of the intraperitoneal IHR with purse string suture plus transfixation suture group was statistically significantly higher compared with the intraperitoneal IHR with purse string suture only and intraperitoneal IHR with transfixation suture only groups. ConclusionsThe combined usage of purse string suture and transfixation suture during laparoscopic intraperitoneal inguinal hernia repair further stimulates mesothelial fibrosis at the hernia sac neck compared with mesothelial fibrosis induced by purse string suture only or transfixation suture only.

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.

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.

Wound cosmesis problems and other postoperative problems of laparoscopic compared to open paediatric inguinal hernia repair: A meta-analysis.

A meta-analysis research was executed to appraise the wound cosmesis problems and other postoperative problems of laparoscopic compared to open paediatric inguinal hernia (IH) repair. Inclusive literature research until March 2023 was done and 869 interconnected researches were revised. The 11 picked researches enclosed 3718 paediatric inguinal hernia were in the utilised researches' starting point, 1948 of them were utilising laparoscopic IH repairs, and 1770 were utilising open IH repairs. Odds ratios (ORs) in addition to 95% confidence intervals (CIs) were utilised to appraise the wound cosmesis problems and other postoperative problems of laparoscopic compared to open paediatric IH repairs by dichotomous approaches and a fixed or random model. Laparoscopic IH repairs had significantly lower wound cosmesis problems (OR, 0.29; 95% CI, 0.16-0.52, P < .001), metachronous contralateral inguinal hernia (MCIH) (OR, 0.11; 95% CI, 0.03-0.49, P = .003), recurrence (OR, 0.34; 95% CI, 0.34-0.99, P = .04) and postoperative problems (OR, 0.35; 95% CI, 0.17-0.73, P = .005), and higher wound score (OR, 12.80; 95% CI, 10.09-15.51, P < .001) compared to open paediatric IH. Laparoscopic IH repairs had significantly lower wound cosmesis problems, MCIH, recurrence, and postoperative problems, and a higher wound score compared to open paediatric IH. However, when interacting with its values, caution must be taken since much of the research had low sample sizes.

Needlescopic Primary Paediatric Inguinal Hernia Repair By Hernia Sac Disconnection And Peritoneal Closure.

To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia. The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24. Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively. Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.

Logistic analysis of the recurrence of laparoscopic percutaneous extraperitoneal repair of pediatric inguinal hernia: A report of 486 cases

BackgroundAlthough the laparoscopic treatment of pediatric inguinal hernia (PIH) has more benefits than traditional surgery, it is difficult to completely avoid the problem of recurrence. The aim of this study was to use a logistic regression model to investigate the causes of recurrence after laparoscopic percutaneous extraperitoneal repair (LPER) of PIH. Patients and methodsFrom June 2017 to December 2021, 486 cases of PIH were performed using LPER in our department. We utilized a two-port approach to implement LPER for PIH. All cases were followed up and the recurrent cases were recorded in detail. We used a logistic regression model to analyze the clinical data in order to find the reasons for recurrence. ResultsWe completed 486 cases with an internal inguinal ostium high ligation using laparoscopic surgery without conversion. Patients were followed for 10–29 months with an average of 18.2 months and 8 cases had recurrent ipsilateral hernia, including 4 recurrent cases in 89 cases (4.49%) using absorbable suture, 1 in 7 cases (14.29%) with internal inguinal ostium larger than 25 mm, 2 in 26 cases (7.69%) with BMI greater than 21, 2 in 41 cases (4.88%) with postoperative chronic constipation. The total recurrence rate was 1.65%. A foreign body reaction occurred in 2 cases, there were no complications such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, and no deaths in this study. Univariate logistic regression analysis showed that patient BMI, ligation suture, diameter of the internal inguinal ostium and postoperative chronic constipation were significant variables (P values 0.093, 0.027, 0.060 and 0.081). The multivariate logistic regression analysis showed that the ligation suture and the diameter of the internal inguinal ostium were the main risk factors for postoperative recurrence, the odds ratio (OR) value were 5.374 and 2.801, the P values 0.018 and 0.046, and the 95% CI were 2.513–11.642 and 1.134–9.125. The area under ROC curve (AUC) for the logistic regression model was 0.735 (the 95% CI 0.677–0.801, P < 0.01). ConclusionAn LPER for PIH is a safe and effective operation, but there still remains a small probability of recurrence. In order to reduce the recurrence rate of LPER, we should improve surgical skills, choose an appropriate ligature and avoid using LPER for a huge internal inguinal ostium (especially over 25 mm). It is appropriate to be converted to open surgery for the patients with a very wide internal inguinal ostium.

Laparoscopic versus Open Incarcerated Inguinal Hernia Repair in Children: A Systematic Review and Meta-Analysis.

Laparoscopic hernia repair (LH) is reported to have superior outcomes in pediatric inguinal hernia repair, but its advantages in incarcerated inguinal hernia (IIH) are not defined. We compare the outcomes of LH versus open hernia repair (OH) for pediatric IIH. We performed a systematic review on all published analyses of LH versus OH for IIH. We identified studies published in 2000 to 2018 from Medline, PubMed, Embase, Google Scholar, and Cochrane databases. We included only studies that compared both surgical techniques on children aged 18 years or younger. Search terms were variations of "incarcerated inguinal hernia," "hernia repair," "laparoscopy," and "child." We categorized complications as major (testicular atrophy, ascending testis, recurrence, iatrogenic visceral injury) and minor (wound infection). Heterogeneity was assessed using I2; meta-analyses were performed using random- or fixed-effects models as appropriate. Weighted mean differences (WMDs) or odds ratios (ORs), with their corresponding 95% confidence intervals (CIs), were used for analysis of continuous and dichotomous variables, respectively. Significance level was at p-value less than 0.05. Our initial search yielded 549 unique citations. Eight retrospective cohort (RC) studies (584 patients) were included in the final analysis (339 LH, 245 OH). Overall, major complications (eight RC; n = 584; OR = 0.38; 95% CI: 0.17-0.88; p = 0.02) were more common in OH. When each complication was assessed individually, there were no differences between groups. The length of hospital stay in the LH group was shorter than in the OH group (five RC; n = 418; WMD = - 1.39; 95% CI, -2.56 to -0.22; p = 0.02). Laparoscopic repair for IIH is associated with less major complications and shorter hospital stay, but data are limited due to the absence of randomized controlled trials.

Is the use of antibiotic prophylaxis in pediatric laparoscopic inguinal hernia repair necessary?

PurposeThe use of surgical antibiotic prophylaxis (SAP) in pediatric laparoscopic inguinal hernia repair is controversial. The aim of this study was to evaluate the impact of SAP on the surgical site infection (SSI) rate after laparoscopic inguinal hernia repair in pediatric patients. MethodsWe conducted a retrospective review of pediatric patients who underwent laparoscopic inguinal hernia repair between January 2017 and June 2022. Patient characteristics, intraoperative characteristics, antibiotic use and SSI within 30 days after the operation were collected via chart reviews. All patients underwent laparoscopic percutaneous extraperitoneal closure. SSI was defined by the Centers for Disease Control and Prevention criteria. Fisher's exact test was used to determine the association between SAP and SSI. ResultsIn total, 365 patients were included in this study. Forty-nine percent (n = 179) received antibiotics, and 51% (n = 186) did not. There were five infection cases (1.4%) in this study. Two (1.1%) were in the SAP group and three (1.6%) were in the no SAP group (p = 1.0). All infections were superficial. There were no adverse events due to antibiotic use. ConclusionA low percentage of SSI after laparoscopic inguinal hernia repair in the pediatric population was found, with no significant difference between the SAP group and the no SAP group. Therefore, the routine use of SAP for pediatric inguinal laparoscopic inguinal hernia repair is not recommended.

Laparoscopic Pediatric Inguinal Hernia Repair with and without Excision of the Hernial Sac

Laparoscopic Pediatric Inguinal Hernia Repair with and without Excision of the Hernial Sac

Effects of ultrasound guided caudal epidural and transversus abdominis plane block on postoperative analgesia in pediatric inguinal hernia repair surgeries

Ultrasound guided caudal epidural block (CEB) and transversus abdominis plane block (TAPB) are two techniques which are used for pain management after inguinal hernia surgeries (IHR). CEB is accepted as gold standard for lower abdominal surgeries while TAPB is more popular. It is aimed to compare ultrasound guided CEB and TAPB for postoperative pain scores, additional analgesic requirement and chronic pain development in pediatric bilateral open IHR. Seventy patients aged 1-7 years undergoing bilateral open IHR were included in this prospective, randomized, double-blinded study. Patients were randomized into group T (Bilateral TAPB) and group C (CEB). Postoperative FLACC (Face, Legs, Activity, Cry, Consolability) scores were evaluated for pain density. Additional analgesic requirement, length of hospital stay was also recorded. Chronic pain is evaluated within a subgroup by using "revised Bieri faces pain scale" in the postoperative second month. Postoperative 15th, 30th, 45th min, first, second hour FLACC scores were similar in both groups (P>0.05). In group C, FLACC scores at postoperative sixth and 24th were significantly higher than group T (1 (0-5) vs 0 (0-2); 1 (0-3) vs 0 (0-2), respectively; P<0.001). Additional analgesic requirement in the postoperative 24h was found to be statistically higher in Group C (56.7%) than in Group T (20%) (P<0.01). Chronic pain development did not differ between the groups (P>0.05). Length of hospital stay was found to be shorter in patients in Group T compared to patients in Group C [10 (5-14) vs 16 (5-18) hours, respectively; P<0.01)]. Our results exhibited that TAPB and CEB for bilateral IHR have similar early analgesic efficacy in children. However; CEB patients experienced higher FLACC scores at the postoperative sixth and 24th hours, and the need for additional analgesics was higher and the length of hospital stay was longer comparing to TAPB. Of note, chronic pain was not observed in any of our subgroup patients (n=21) who are older than four years. For bilateral IHR, US-guided CEB and TAPB have similar analgesic efficacy in the first six hours, postoperatively, However, TAPB appears to be slightly superior than CEB in terms of subacute pain and length of stay which is still not clinically distinctive.

Long-Term, Patient-Reported Outcomes of Pediatric Laparoscopic and Open Inguinal Hernia Repair

INTRODUCTION: Long-term outcomes studies of pediatric inguinal hernia repair have been limited and primarily conducted via chart review. We assessed long-term outcomes, including recurrence, through a questionnaire, hypothesizing that laparoscopic repair would not have higher recurrence rate compared with open. METHODS: Families of patients <18 years old undergoing inguinal hernia repair from 2011 to 2018 were administered a questionnaire in 2021 assessing outcomes including recurrence, long-term pain, and cosmetic satisfaction. Chart review was also conducted. Student’s t-tests or Wilcoxon rank sum tests as well as chi-square tests were performed. Time-dependent analysis of laparoscopic vs open recurrence was performed using Kaplan-Meier analysis and log-rank test. RESULTS: Of 506 children, 325 (64%) underwent laparoscopic repair and 181 (36%) open. There was no difference in median (interquartile range) age (20 (4–68) vs 21 (4–66) months, p = 0.69), mean weight (14 ± 12 vs 17 ± 16 kg, p = 0.06), or preoperative incarceration (10% vs 7%, p = 0.22) by approach. The questionnaire was completed by 57% (n = 288) of families for a median follow-up time of 70 (46–93) months. There was no difference in demographics or operative approach between respondents and nonrespondents (all p > 0.05). The recurrence rate among respondents was 3.5% (n = 10) and occurred at a median of 7 (4–14) months after index repair. There was no difference in recurrence after laparoscopic vs open repair (Figure; p = 0.86).FigureCONCLUSION: Patient-reported outcomes were excellent after pediatric inguinal hernia repair in our study with up to 10 years of follow-up. The recurrence rate is equivalently low regardless of laparoscopic or open approach, but it is likely underestimated when assessed by chart review alone.

Open and laparoscopic inguinal hernia repair in children: A regional experience

PurposeThe optimal approach for pediatric inguinal hernia repair continues to be debated. We conducted a regional retrospective study to assess rates of recurrence and metachronous hernias after open repair (OPEN) and laparoscopic repair (LAP) MethodsA retrospective cohort study was conducted at two children's hospitals that serve a region of approximately 4 million people. All patients < 14 years old undergoing OPEN or LAP by pediatric surgeons during a 5-year period (2011 – 2015) were analyzed after a minimum follow up of 4 years. Cox proportional regression was used to compare the effect of surgical approach on hernia recurrence and metachronous contralateral hernias. ResultsA total of 1,952 patients, 587 female (30%) and 1365 male (70%), had 2305 hernias repaired. Median post operative follow up time was 6.6 years (range 4–9 years). OPEN and LAP were performed for 1827 (79%) and 478 (21%) hernias, respectively. There were no significant differences in rate of prematurity, age at repair, or frequency of emergent repair. LAP was associated with a lower incidence of metachronous contralateral hernias compared to OPEN (1.4% vs 3.8%, p = 0.047), and a higher incidence of recurrence (9% vs 0.9%, p < 0.001). After adjusting for confounders, LAP had a higher rate of recurrence than OPEN (hazard ratio 10.4, 95% CI 6–18.1).The recurrence rate did not decrease over the study period (p = 0.731). ConclusionLaparoscopic inguinal hernia repair in children resulted in a modest decrease in the incidence of metachronous hernias, at the cost of a significant increase in recurrence. Type of StudyRetrospective Comparative Study. Level of evidenceLevel III.

Benefits of Contralateral Patent Processus Vaginalis Closure During Laparoscopic Surgery for Inguinal Hernia in Female Children.

After more than a decade, an accurate description of the current state of pediatric inguinal hernia repair still an issue of contention. Improvement of techniques together with patient-entered intervention that account for the experiences related to individual disease characteristics have become an important factor of which the surgeon must be aware. Therefore, the aim of this study is to analyze a potential treatment for metachronous contralateral inguinal hernia (MCIH) in children during laparoscopic assisted percutaneous internal inguinal ring suturing (PIRS). In a prospective clinical study, carried out at the University Clinic for Pediatric Surgery in Skopje, Republic of North Macedonia, we analyzed the data from 49 female children, aged 1-14 years old, with clinically diagnosed congenital inguinal hernia treated via PIRS. The position of hernias on the right side was 29 (59.2%) on the left side was 19 (38.8%) and on both sides was 1 (2.0%). With intraoperative assessment, it was determined that in 33 (67.3%) participants there was no presence of a hidden hernia, while in 16 (32.7%), there was indeed the presence of a hidden hernia. Of the hidden hernias determined laparoscopically [16 (100%)], 8 (50%) were left and right hidden hernias, all treated laparoscopically. The PIRS technique is a procedure where the basic advanced treatment is exploration. This also included the adequate treatment of other pathologies, such as the prophylactic closure of a contralateral patent processus vaginalis with simultaneous treatment as there is the potential for hernia in future, therefore reducing the number of metachronous inguinal hernias.

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.

Transumbilical Single-Site Laparoscopic Intraperitoneal Closure of the Internal Inguinal Ring for Pediatric Inguinal Hernia.

BackgroundA new novel technique for pediatric inguinal hernia (PIH) repair, namely, transumbilical single-site laparoscopic intraperitoneal closure (TUSLIC) of the internal inguinal ring (IIR) with a single instrument, was introduced. The short-term follow-up of TUSLIC for PIH was compared with that of transabdominal multiple-site laparoscopic extraperitoneal closure (TAMLEC) for PIH.MethodsDescriptive variables, perioperative clinical features, and short-term outcomes were retrospectively analyzed and compared between the patients who underwent TUSLIC and those who underwent TAMLEC.ResultsIn total, 289 patients were enrolled in this study. Of these, 190 patients received TUSLIC, and 99 patients received TAMLEC. The descriptive variables (including sex, age, weight, and preoperative diagnosis of patients) were comparable between the two groups (P-values were 0.12, 0.71, 0.69, and 0.23, respectively). The mean operative times for unilateral hernia repair and bilateral hernia repairs in TAMLEC group were significantly less than those in TUSLIC group (P < 0.01). The values of surgical site infection, umbilical bleeding, testicular atrophy, iatrogenic ascent of the testis, and secondary hydrocele were not significantly different between the two groups. There were no suture granulomas, and recurrence occurred in TUSLIC group, though at a significantly lower rate than in TAMLEC group (P < 0.05).ConclusionsTUSLIC is a feasible, safe, and reliable minimally invasive method for PIH. Compared with TAMLEC, TUSLIC has the advantages of minimized complications and a low recurrence rate.

A Canadian national survey: Perspectives on routine pathological examination of hernia sacs after inguinal hernia and hydrocele repair among pediatric urologists, surgeons, and pathologists

This study aims to understand perspectives on routine pathological examination of hernia sacs following pediatric inguinal hernia and hydrocele repair among Canadian pediatric urologists, surgeons, and pathologists. All active members of Pediatric Urologists of Canada (PUC), Canadian Association of Pediatric Surgeons (CAPS), and the divisional heads of anatomical pathology at the Canadian children's hospitals (AP) were invited to participate between June 2019 and January 2021 in an anonymous multiple-choice-based questionnaire. The response rates were 71% from PUC (24/34), 20% from CAPS (25/130), and 64% from AP (7/11). The majority of the surgeons (PUC:54%, CAPS:68%) did not routinely send hernia sacs for pathological examination after inguinal hernia repair. Most felt there was a little value in such examination (PUC:96%, CAPS:72%). Among those who submit hernia sacs, the majority did not receive reports that were clinically significant impacting patient management (PUC:82%, CAPS:50%). On the other hand, the pathologists had mixed opinion on the value of examining hernia sacs. Most of them only did gross examination (86%), unless requested by surgeons or concerning features were noted on gross examination. The majority have found clinically meaningful abnormal findings (71%), including vas deferens and portions of the spermatic cord. Currently, there are no evidence-based clinical guidelines on pathological assessment of hernia sacs after pediatric inguinal hernia and hydrocele repair. Instead of making it mandatory, future guidelines should highlight specimens that should be submitted for further investigations (e.g., challenging cases where inadvertent surgical injuries might have occurred). Future studies should also address whether patients who may be at higher risk of having clinically significant pathology can be identified pre- or perioperatively to more efficiently triage specimens that would benefit from pathological examination. Limitation of the study includes low response rate from the CAPS members during the COVID-19 pandemic. While most of the pediatric urologists and surgeons felt there is a little value of pathological examination of hernia sacs following inguinal hernia and hydrocele repair, half of the anatomical pathologists felt there is value. Future studies should aim to establish evidence-based clinical guidelines taking stakeholders perspectives into consideration.