Kumar Ameet, Ramakrishnan T S
Department of Surgery, Air Force Hospital, Kanpur Cantt, Uttar Pradesh, India.
J Minim Access Surg. 2013 Jan;9(1):7-12. doi: 10.4103/0972-9941.107126.
Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive - from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital.
Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis.
Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8-25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries.
Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre.
先天性腹股沟疝是小儿外科常见问题，经腹股沟切口疝囊高位结扎术是金标准术式。在过去20年里，微创手术（MIS）对这种传统手术提出了挑战。经过一段时间，MIS技术不断发展，使其创伤更小——从三孔到两孔，现在发展到单孔技术。所有使用单孔技术的研究均来自三级医疗中心。我们对Ozgediz等人描述的技术进行了改良，回顾了这一新颖术式的临床结果，并阐述了我们在二级医院的经验。
对2007年9月至2010年6月间在单一中心由一名外科医生为31例儿童（29例男性，2例女性，年龄8个月至13岁）行腹腔镜手术治疗的37例疝进行前瞻性研究。在腹腔镜引导下，用2-0不可吸收缝线在腹膜外环绕内环，并在腹膜外打结。分析的数据包括手术时间、操作难易程度、隐匿性鞘状突未闭（PPV）、并发症及美观情况。
共修复16例右侧疝（52%）、14例左侧疝（45%）和1例双侧疝（3%）。5例单侧疝（16.66%），均为左侧，对侧存在PPV并进行了修复（P = 0.033）。单侧疝和双侧疝修复的平均手术时间分别为13.20（8 - 25）分钟和20.66分钟（17 - 27分钟）。仅1例修复（2.7%）复发，另1例术后出现鞘膜积液（2.7%）。1例（2.7%）因疝内容物无法完全回纳而需要额外放置一个端口。未出现缝线脓肿/肉芽肿、明显的精索损伤、睾丸萎缩或神经损伤。
单孔腹腔镜腹股沟疝修补术在儿科患者中可安全实施。它使微创手术的益处能够扩展到资源有限的二级医院所治疗的患者。器械最少化及避免体内打结的优点使其成为二级医疗中心可行的技术。
