Department of Pediatric Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan.
J Endourol. 2012 May;26(5):474-7. doi: 10.1089/end.2011.0498. Epub 2011 Dec 14.
This article presents the extracorporeal ligation of inguinal hernia defects using an epidural needle and preperitoneal hydrodissection.
Thirteen children underwent laparoscopic extracorporeal ligation of their hernia defect using an epidural needle and preperitoneal hydrodissection. A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision, a Veress needle for forceps was inserted halfway between the umbilicus and the anterior superior iliac spine on the contralateral side of the hernia, and a 17-gauge epidural needle was inserted at the point of the internal inguinal ring. The hernia defect was closed extracorporeally by a nonabsorbable suture, which was introduced into the abdomen through the epidural needle on the lower half of the hernia defect and withdrawn on the opposite side by a wire-loop through the epidural needle going along the upper half side of the hernia defect in a series of movements. When a contralateral hernia defect is present, laparoscopic-assisted extracorporeal ligation of the contralateral hernia defect is performed during the same operation.
All patients were discharged uneventfully from the hospital within 24 hours postoperatively. The mean follow-up period is 6.1 months (range 2-12 mos), and no recurrence has been observed to date.
This article describes a unique technique of extracorporeal circuit suturing of inguinal hernia defects using a minimally invasive technique as afforded by an epidural needle.
本文介绍了一种使用硬膜外针和腹膜前水分离术进行腹股沟疝缺损的体外结扎方法。
13 名儿童接受了腹腔镜下使用硬膜外针和腹膜前水分离术进行的疝缺损体外结扎。通过脐下切口放置 5mm 的手术腹腔镜套管针，在疝对侧的脐和前上棘之间的中点插入 Veress 针用于钳子，在腹股沟内环处插入 17 号硬膜外针。通过硬膜外针将不可吸收缝线引入腹部，将疝缺损的下半部分结扎体外，然后用线环将缝线从硬膜外针上引出，沿着疝缺损的上半部分进行一系列动作，将缝线从对侧引出。当存在对侧疝缺损时，可在同一手术中进行腹腔镜辅助对侧疝缺损的体外结扎。
所有患者术后 24 小时内均顺利出院。平均随访时间为 6.1 个月（范围 2-12 个月），目前尚未观察到复发。
本文描述了一种使用硬膜外针微创技术进行腹股沟疝缺损体外缝线缝合的独特技术。
