Shalaby Rafik, Shams Abdul Moniem, Mohamed Soliman, el-Leathy Mohamed, Ibrahem Medhat, Alsaed Gamal
Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Nasr City, 11884, Cairo, Egypt.
J Pediatr Surg. 2007 Jul;42(7):1259-62. doi: 10.1016/j.jpedsurg.2007.02.018.
Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.
A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.
In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.
The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.
许多研究描述了腹腔镜在儿童腹股沟疝治疗中的安全性和有效性。针式腹腔镜技术最近已用于修复腹股沟疝，这使得这类手术更具美观性且侵入性更小。然而，很少有报告描述其在嵌顿性腹股沟疝治疗中的作用。本研究的目的是评估针式腹腔镜治疗儿童嵌顿性腹股沟疝的可行性和疗效。
对总共250例表现为嵌顿性腹股沟疝的儿童进行分析，其中包括190名男孩和60名女孩。他们的年龄从6个月至6岁（平均年龄2岁）。在170例（68%）病例中，手法复位成功。其中100例患者在同一天接受确定性手术，而其余70例患者在1至3天后接受针式腹腔镜手术。在80例（32%）病例中，外部手法复位失败。这些儿童接受了紧急针式腹腔镜复位和疝修补术。嵌顿疝很容易复位，内容物在直视下得到彻底检查。然后在同一手术中进行疝修补。
所有患者均无需将手术转为开放手术。在同一手术中立即增加针式腹腔镜疝修补术，手术时间无显著增加。平均手术时间为10分钟。无术中并发症。
该研究表明，针式腹腔镜治疗儿童嵌顿性腹股沟疝是可行、安全、简便的，且优于开放手术。除了在直视下复位嵌顿疝内容物外，它还能同时对疝缺损进行确定性治疗，而不会显著增加手术时间和住院时间。
