Department of Pediatric Surgery, Taizhou Hospital, Zhejiang Province, China.
J Pediatr Surg. 2011 Dec;46(12):2417-20. doi: 10.1016/j.jpedsurg.2011.08.013.
BACKGROUND/PURPOSE: There has been great interest in natural orifice transluminal endoscopic surgery in recent years. We report another new approach for pediatric inguinal hernia repair: transumbilical endoscopic surgery (TUES). Compared with the natural orifice transluminal endoscopic surgery technique, TUES can obtain similar scarless results on the abdomen.
In our hospital, 2-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through 2 intraumbilical incisions, two 5-mm trocars were inserted into the abdomen under laparoscopic guidance. With the use of a needle-holding forceps, a round needle with 2-0 nonabsorbable suture material was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and intraperitoneal knot-tying was performed.
A total of 76 inguinal repairs were performed in 64 children (age range, 6 months to 9 years; median, 3.8 years; 44 boys, 20 girls). All operations were completed successfully by TUES, with the exception of one case of intraoperative bleeding because the inferior epigastric vein was punctured. The mean operating time was 20 minutes (range, 15-30 minutes). No postoperative bleeding, hydrocele, or scrotal edema in this group of patients was found, and there were no known cases of postoperative testicular atrophy or hypotrophy nor hernia recurrence on the symptomatic side.
Our preliminary experience shows satisfactory outcomes with TUES for completely enclosing inguinal hernias in children. This technique appears to be safe, effective, and reliable. The cosmetic result is excellent.
背景/目的：近年来，人们对经自然腔道内镜手术（NOTES）产生了浓厚的兴趣。我们报告了一种治疗小儿腹股沟疝的新方法：经脐内镜手术（TUES）。与NOTES 技术相比，TUES 可在腹部获得类似的无痕效果。
在我院，2 孔 TUES 是治疗小儿腹股沟疝的标准方法。通过 2 个脐内切口，在腹腔镜引导下插入 2 个 5mm 套管针。使用持针器，将带有 2-0 非吸收缝线的圆针从靠近内环的前腹壁腹膜外引入腹腔。在腹膜外围绕内环用荷包缝线关闭疝囊口，并在内镜下进行腹腔内打结。
64 例儿童（年龄 6 个月至 9 岁；中位数 3.8 岁；44 例男孩，20 例女孩）共行 76 例腹股沟疝修补术。除 1 例因穿刺下腹部静脉导致术中出血而中转开腹外，其余均成功完成 TUES 手术。手术平均时间为 20 分钟（15-30 分钟）。该组患儿均无术后出血、阴囊水肿或水肿，无已知的术后睾丸萎缩或发育不良或症状侧疝复发病例。
我们的初步经验表明，TUES 治疗小儿腹股沟疝完全封闭的效果令人满意。该技术安全、有效、可靠。美容效果极佳。
