Esposito Ciro, Alicchio Francesca, Giurin Ida, Castellano Michele, Settimi Alessandro
Department of Pediatrics, Federico II University of Naples, Naples, Italy.
J Laparoendosc Adv Surg Tech A. 2012 Jan-Feb;22(1):113-6. doi: 10.1089/lap.2011.0324. Epub 2011 Nov 1.
The aim of this article is to standardize the laparoscopic technique to treat direct inguinal hernia in pediatric patients.
In the last 3 years we treated laparoscopically 163 patients with a diagnosis of inguinal hernia. In 7 patients we discovered laparoscopically a direct inguinal hernia. This study is focused on the management of these 7 cases (4 girls and 3 boys; median age 4.6 years). They presented a right defect in 4 cases and a left defect in 3 cases. Six of 7 patients had been already operated for an inguinal hernia and presented a recurrence of the hernia. We used three trocars, 5-mm 0 degree optic, and two 3-mm instruments. In each case, after the resection of the lipoma using the hook cautery, the defect was closed by means of separated stitches. In every case we used the vesical ligament as an autologous patch to reinforce the closure of the defect.
The average operative time was 35 minutes. All the procedures were performed in a day-hospital setting. We had neither conversions nor complications in our series. With a minimum follow-up of 1 year, we had no recurrence.
Laparoscopic identification and repair of direct inguinal hernia in children is a safe and effective procedure to adopt. The key points of the technique are the resection of the lipoma, the closure of the defect using separated, nonabsorbable sutures, and the use of the vesical ligament to reinforce the suture. We believe that in case of recurrence of inguinal hernias after inguinal approach, laparoscopy is the gold standard technique to identify and treat the cause of the recurrence itself.
本文旨在规范小儿腹股沟直疝的腹腔镜治疗技术。
在过去3年中，我们对163例诊断为腹股沟疝的患者进行了腹腔镜治疗。其中7例患者经腹腔镜检查发现为腹股沟直疝。本研究聚焦于这7例患者（4例女孩和3例男孩；中位年龄4.6岁）的治疗。其中4例为右侧缺损，3例为左侧缺损。7例患者中有6例曾因腹股沟疝接受手术，此次出现疝复发。我们使用了三个套管针、5毫米0度观察镜以及两个3毫米器械。在每例手术中，使用钩形电灼器切除脂肪瘤后，通过间断缝合关闭缺损。在每例手术中，我们均使用膀胱韧带作为自体补片加强缺损的关闭。
平均手术时间为35分钟。所有手术均在日间医院环境下进行。我们的系列研究中既没有中转开腹情况，也没有出现并发症。随访至少1年，无复发情况。
小儿腹股沟直疝的腹腔镜识别与修复是一种安全有效的手术方法。该技术的关键点在于脂肪瘤的切除、使用间断不可吸收缝线关闭缺损以及使用膀胱韧带加强缝合。我们认为，对于腹股沟疝修补术后复发的情况，腹腔镜检查是识别和治疗复发原因的金标准技术。
