Schier Felix
Department of Pediatric Surgery, University Medical Center Mainz, 55101 Mainz, Germany.
J Pediatr Surg. 2006 Jun;41(6):1081-4. doi: 10.1016/j.jpedsurg.2006.02.028.
This series prospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair.
A total of 712 inguinal hernias were corrected laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). The internal inguinal ring was closed with a 4-0 nonabsorbable suture using 2-mm instruments. Patients were prospectively video-documented.
There were no serious intraoperative complications. Operating time was comparable to open surgery. The contralateral inner ring was open on the left side in 16% of boys and 12% of girls, and on the right side in 18% of boys and 32% of girls. Direct hernias were found in 2.3%, femoral hernias in 1%, hernias en pantalon in 0.7%, and a combination of indirect and femoral hernia in 0.2%. Follow-up to date is 1-84 months (median 39 months). There were 4.1% hernia recurrences, 0.7% hydroceles and 0.2% testicular atrophies. Cosmesis is excellent.
Laparoscopic inguinal hernia repair can be a routine procedure with results comparable to those of open procedures. It is well suited for recurrences. The vas remains untouched. The visualization of structures is clear and leads to a defect-specific closure. The advantages of the laparoscopic approach include the following: its technical ease, it is an outpatient procedure, the cord structures remain untouched, the type of hernia is obvious, trocar placement is identical for any side or hernia type, clear visualization of the anatomy. Routine video documentation renders the diagnostic accuracy objective and absolute. Finally, recurrences are easier dealt with, be it from a previous open or from a laparoscopic approach. Although recurrences were slightly more frequent in the early stages, now they are closer to the rate with the open procedure.
本系列研究前瞻性评估了连续接受腹腔镜疝修补术的儿童个人病例系列。
542名儿童（396名男孩和146名女孩，年龄4天至14岁，中位数1.6岁）共712例腹股沟疝通过腹腔镜进行了修复。使用2毫米器械用4-0不可吸收缝线关闭腹股沟内环。对患者进行前瞻性视频记录。
无严重术中并发症。手术时间与开放手术相当。左侧对侧内环在16%的男孩和12%的女孩中开放，右侧在18%的男孩和32%的女孩中开放。发现直疝2.3%，股疝1%，裤型疝0.7%，间接疝和股疝合并0.2%。随访时间为1至84个月（中位数39个月）。疝复发率为4.1%，鞘膜积液0.7%，睾丸萎缩0.2%。美容效果极佳。
腹腔镜腹股沟疝修补术可成为一种常规手术，其结果与开放手术相当。它非常适合复发性疝。输精管未受影响。结构可视化清晰，可实现针对缺损的闭合。腹腔镜手术方法的优点包括：技术操作简便，为门诊手术，精索结构未受影响，疝的类型明显，任何一侧或疝类型的套管针放置相同，解剖结构可视化清晰。常规视频记录使诊断准确性客观且绝对。最后，无论是既往开放手术还是腹腔镜手术导致的复发，都更容易处理。尽管早期复发略为常见，但现在复发率已接近开放手术的复发率。
