Michael E. DeBakey Department of Surgery,Baylor College of Medicine, Houston, TX 77030, USA.
J Pediatr Surg. 2011 Dec;46(12):2349-52. doi: 10.1016/j.jpedsurg.2011.09.027.
The use of transinguinal laparoscopy for contralateral groin exploration during unilateral inguinal hernia repair has gained popularity. Controversy exists, however, regarding its use in older children. We report a large, single-surgeon series describing the safety and effectiveness of this procedure.
A retrospective review was completed of all cases of open inguinal hernia repair from 1997 to 2009 performed by the senior author. Patients were explored laparoscopically through the ipsilateral hernia sac to assess the contralateral groin. Exclusion criteria were an inadequate sac or preoperatively diagnosed bilateral inguinal hernia.
A total of 649 children underwent open inguinal hernia repair. A preoperative diagnosis of bilateral hernia was made in 18% (n = 117), and of the 532 unilateral cases, an inadequate sac was present in 15% (n = 79). Transinguinal laparoscopic exploration was performed on the remaining 453 children. A hernia or contralateral patent processus vaginalis (CPPV) was found in 38% of children (n = 173). In children older than 8 years, 32% demonstrated a hernia or CPPV on laparoscopic exploration. No complications occurred because of laparoscopy.
Transinguinal laparoscopic exploration is safe and effective and should be routinely performed in pediatric patients of all ages because of the high prevalence of contralateral hernia and CPPV.
经腹侧入路腹腔镜探查在单侧腹股沟疝修补术中用于对侧腹股沟的应用已越来越受欢迎。然而，对于年龄较大的儿童，其应用存在争议。我们报告了一项由单一术者进行的大型系列研究，描述了该手术的安全性和有效性。
回顾性分析了 1997 年至 2009 年由高级作者进行的所有开放式腹股沟疝修补术的病例。通过同侧疝囊对患者进行腹腔镜探查，以评估对侧腹股沟。排除标准为疝囊不充分或术前诊断为双侧腹股沟疝。
共有 649 名儿童接受了开放式腹股沟疝修补术。术前诊断为双侧疝的占 18%（n=117），532 例单侧病例中，疝囊不充分的占 15%（n=79）。对其余 453 名儿童进行了经腹侧入路腹腔镜探查。38%的儿童（n=173）发现有疝或对侧未闭的鞘状突。在 8 岁以上的儿童中，32%的腹腔镜探查发现有疝或 CPPV。由于腹腔镜检查，没有发生任何并发症。
经腹侧入路腹腔镜探查安全有效，应常规用于所有年龄段的小儿患者，因为对侧疝和 CPPV 的患病率很高。
