Treatment Of Pediatric Inguinal Hernia Research Articles

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Clinical efficacy of laparoscopic treatment of pediatric inguinal hernia: a meta-analysis.

To evaluate operative outcomes and postoperative complications of laparoscopic treatment for pediatric inguinal hernia using meta-analysis. We conducted a comprehensive search of databases including the Chinese Journal Full-text Database, Wanfang, PubMed, Web of Science, ScienceDirect, VIP Chinese Science, and Technology Journal Database, ProQuest, JSTOR, Wiley, and IEEE Xplore. Relevant randomized controlled trials (RCTs) on laparoscopic surgery for pediatric inguinal hernia were collected, and data were analyzed using Review Manager 5.3. A total of 18 RCTs involving 5,750 children (3,357 in the laparoscopic group and 2,393 in the open surgery group) were included. Compared to the open surgery group, the laparoscopic group had significantly shorter operative times for bilateral hernias [(mean difference (MD) = -11.43, P = 0.04)], and lower incidences of metachronous contralateral inguinal hernia (MCIH) (MD = 0.17, P = 0.02) and testicular ascent (MD = 0.19, P = 0.03). However, there were no significant differences in operative time for unilateral hernia (MD = 0.47, P = 0.87), complication rate (MD = 0.87, P = 0.60), postoperative recurrence (MD = 1.46, P = 0.18), incision infection rate (MD = 2.54, P = 0.34), or testicular atrophy rate (MD = 0.36, P = 0.19). Laparoscopic surgery for pediatric inguinal hernia is effective, especially for bilateral cases, reducing operative time and lowering the risk of MCIH and testicular ascent.

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 totally extraperitoneal ligation for pediatric inguinal hernia: a novel surgical treatment.

Laparoscopic repair is widely performed for the management of pediatric inguinal hernia (PIH), and different laparoscopic surgical methods are used. Herein, we present the application of laparoscopic totally extraperitoneal ligation (TEPL), which is a novel surgical method for PIH repair and is similar to traditional high ligation. In this study, 103 pediatric patients underwent laparoscopic TEPL for inguinal hernia. Data including demographic characteristics, clinical presentation, time of surgery, length of hospital stay, and postoperative complications were analyzed retrospectively. The patient's median age at surgery was 4.3years, and the median body weight at surgery was 18kg. The preoperative diagnoses were as follows: n = 53, right inguinal hernia; n = 45, left inguinal hernia; and n = 5, bilateral inguinal hernia. All patients were discharged on the day of surgery. The operative times were 27.2min for unilateral inguinal hernia and 28.8min for bilateral inguinal hernia. All patients, except one who had scrotal bruise, did not present with postoperative complications. Laparoscopic TEPL, which is similar to traditional high ligation, is used for the treatment of PIH. Moreover, it is safe, beneficial, and feasible. Double ligation is performed on the extraperitoneal space, and the assessment of contralateral patent processus vaginalis is not complex. However, further studies should be conducted to assess for long-term outcomes.

Evaluasi Rekurensi Laparoskopi-assisted Ligasi Ekstraperitoneal dengan Penggunaan IV Catheher 18G pada Pengobatan Hernia Inguinalis Anak

Treatment of pediatric inguinal hernia can be done with conventional and laparoscopy methods. Laparoscopic percutaneous extraperitoneal ligation closes the internal inguinal ring by making sutures that are knotted by the extraperitoneum and implanted in the subcutaneous tissue. The rate of recurrence and postoperative complications are still a major concern. Division of pediatric surgery at Dr. M.Djamil Hospital Padang made modifications using an 18G intravenous catheter that was bent to form an angle of 100-150. This study aims to determine the success of laparoscopic herniotomy with modification performed by recurrence rate. This study is a retrospective analytic design method. Data was taken from the medical record status of pediatric inguinal hernia patients undergoing laparoscopic herniotomy at RSUP Dr. M.Djamil Padang from January 2018 -December 2019. Data were analyzed by crosstabulation using the Fisher test. Recurrence was seen in 7,4% of patients (5/68 patients). Three cases in boys and 2 cases in girls. Two cases in the age group ≤1 year and 3 cases in the age group &gt;1 year. One case in the weight group ≤10 kg and 4 cases in the bodyweight &gt;10 kg. Three recurrent cases appeared on the right side and 2 cases on the left side. There were no differences in the incidence of recurrence after laparoscopic-assisted extraperitoneal ligation with intravenous catheter 18G as needle puncture according to age, sex, body weight, and location of the hernia.

Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience.

Percutaneous internal ring suturing (PIRS) is a minimally invasive surgical technique of laparoscopic hernia repair in children under the control of a laparoscope placed in the umbilicus. The aim of this study was to evaluate the management and postoperative outcomes of PIRS for inguinal hernia repair in children. All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in the prospective cohort study. The following parameters were recorded: age, gender, body mass index, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, and intraoperative or postoperative complications and recurrences were recorded. A total number of 228 PIRS procedures were performed in 188 children [126 (67%) male individuals and 62 (33%) female individuals] with a median age of 4 [interquartile range (IQR), 2 to 6] years and a median follow-up of 46 (IQR, 38 to 52) months. From the total number of hernia repairs there were 99 (52.7%) right, 49 (26.1%) left, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR, 8 to 12) minutes for unilateral and 16 (IQR, 14 to 20) minutes for a bilateral repair. The median hospital stay was 24 (IQR, 8 to 24) hours. Regarding intraoperative complications, only 3 (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in 3 male children, hydrocele was recorded; in 2 cases, hydrocele resolved spontaneously and 1 required surgical treatment. No cases of other complications including testicular atrophy or recurrence were recorded. In a hands of an experienced pediatric laparoscopic surgeon, PIRS is a simple, safe, and effective technique for inguinal hernia repair in children with excellent outcomes, cosmetic results, and a low incidence of complications and recurrence.

Laparoscopic assisted percutaneous internal ring suturing for inguinal hernia repair in pediatrics

Several laparoscopic techniques used in treatment of pediatric inguinal hernia differ in their approach to the internal inguinal ring, suturing and knotting techniques, number of ports, endoscopic instruments used and hernia sac dissection technique. The aim of this study was to evaluate efficacy and safety of laparoscopic assisted percutaneous internal ring suturing for inguinal hernia repair in pediatrics. Laparoscopic assisted percutaneous internal ring suturing was performed under general endotracheal anesthesia on 54 children with 64 hernias during the period from July 2018 to June 2019. Under laparoscopic-guided vision a 2-0 Prolene® thread inside an 18-gauge epidural needle was placed through the abdominal wall into the peritoneal cavity, then the thread passed under the peritoneum around the internal ring. The knot was tightened from outside and placed in the subcutaneous space. The mean operative time was 14.18 min for unilateral and 21.2 min for bilateral hernias. Cosmetic results are excellent with almost invisible scars. There were no intraoperative and six postoperative complications (recurrence in three cases, transient hydroceles in two boys and one patient had stitch sinus). Laparoscopic assisted percutaneous needle repair of congenital inguinal hernia seems to be a simple minimally invasive procedure in small ring diameter with excellent cosmetic results. But I do not recommend this technique due to high rate of complications and recurrence, also simplicity of the technique can be regarded as a hindrance to the surgeons in training from challenging their skills to be ready for the more complex scenarios.

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia.

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy. From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed. All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15min (8-25min) for 557 unilateral hernias and 21min (14-36min) for 233 bilateral hernias. The mean postoperative stay was 20h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42months. No obvious scar was present postoperatively. Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

Laparoscopic Repair of Pediatric Inguinal Hernia by Disconnection of the Hernial Sac

AbstractBackground: Several techniques are used for laparoscopic treatment of pediatric inguinal hernia (PIH). Disconnection and peritoneal closure was described by Becmeur in 2004, as an effective technique mimicing open technique. Others described disconnection only as an effective laparoscopic treatment of PIH specially for small defects. Here in, we describe the short term results of laparoscopic disconnection only of the hernial sac.Patients and Methods: This prospective clinical study was carried out in the Pediatric Surgery Unit, Tanta University Hospital, during the period from March 2016 to March 2017, on 15 patients with 20 pediatric inguinal hernias. All the cases were subjected to laparoscopic disconnection of the hernia sac without closure of peritoneum over internal ring.Results: The operative data as well as postoperative course and complications specially recurrence were reported. Twenty hernias were repaired laparoscopically by disconnection of sac only. Operative time ranged from 30 to 42 minutes for unilateral cases while in bilateral cases, it ranged from 35 to 50 minutes. All cases were repaired laparoscopically with no conversion. Three recurrences occurred, all with ring diameter more than 10mm.Conclusion: With enough experience LIHR is safe, feasi-ble, and has no major complications and a small incidence of minor complications. With experienced hands U/S is a good tool for examining the contralateral side in unilateral PIH and for detection of a CPPV (a latent hernia). sac disconnection is an effective laparoscopic treatment of PIH. However, it is associated with an unacceptable recurrence rate (15%) in hernias >10mm in diameter. However, IRD is not the only factor contributing to recurrence.

Inguinal hernia repair by Bianchi incision in boys: a retrospective study.

Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision. A total of 3300 boys (1-144months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7days, 1month, and 1year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated. Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0 ± 2.3min for unilateral cases and 25.2 ± 4.2min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect. Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.

Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases

Background/PurposePercutaneous internal ring suturing (PIRS) is a minimally invasive method for repair of pediatric inguinal hernia. In this study we report our experience with PIRS. MethodsAll children >10kg presenting to our institute between June 2013 and March 2015 with a diagnosis of indirect inguinal hernia or communicating hydrocele underwent laparoscopic repair using PIRS technique. Patients' gender, age at surgery, side of inguinal hernia/communicating hydrocele at diagnosis, peroperative findings, surgical and anesthesia times plus follow-up findings were collected. ResultsTwo-hundred thirteen patients underwent 250 procedures. Inguinal hernia or communicating hydrocele was diagnosed on the right side in 113 (53.1%), the left side in 75 (35.2%) and bilaterally in 25 patients (11.7%). Contralateral hernia was found in 35 patients (16.4%). Mean surgery time was 14.3min for unilateral and 20.4min for bilateral PIRS, and mean anesthesia time was 33.6min for unilateral and 39.1min for bilateral PIRS. Average follow-up time was 9.6months. Recurrence was seen in 3 (1.4%) and complications in 6 patients (2.8%). ConclusionPIRS is a simple, safe and effective method for the treatment of inguinal hernia and communicating hydrocele in children.

Minimal access surgery of pediatric inguinal hernias: a review

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.