Tan Serena Y, Stevens Megan J, Mueller Claudia M
1 Department of Surgery, Stanford Hospital and Clinics , Stanford, California.
J Laparoendosc Adv Surg Tech A. 2013 Nov;23(11):946-8. doi: 10.1089/lap.2013.0199. Epub 2013 Sep 9.
Femoral hernias in young children are relatively rare and can be difficult to diagnose as they are often mistaken for inguinal hernias. Although a few reports have described laparoscopic techniques, most traditional repair methods still focus on an open approach using either an inguinal or crural incision. Here we describe a laparoscopic-assisted technique that is buttressed by a cigarette of mesh for the repair of this uncommon pediatric entity.
We report three consecutive cases of children with femoral hernias repaired with only two small incisions: a 5-mm umbilical incision for a 30° camera and a 1-cm groin incision for dissection and ligation of the hernia sac. After sac ligation, the repair was buttressed with a small mesh cigarette.
Using this approach, right femoral hernias were repaired without complication in three children, between 8 and 9 years of age. Two patients had ipsilateral indirect inguinal hernias. No contralateral groin hernias were identified in any of the patients. Operative time averaged 40 minutes, recovery time was quick, and follow-up at 6 months revealed good cosmesis.
This laparoscopic-assisted approach to pediatric femoral hernia repair with a small mesh plug is a safe, effective, and efficient technique. Because only two incisions are required, postoperative pain is minimal, and cosmesis is excellent. Nonetheless, more patients and longer follow-up will be required to accurately judge the long-term implications of this novel technique.
小儿股疝相对罕见，常被误诊为腹股沟疝，故诊断较为困难。尽管有少数报告描述了腹腔镜技术，但大多数传统修复方法仍侧重于采用腹股沟或股部切口的开放手术。在此，我们描述一种腹腔镜辅助技术，该技术采用网状卷烟进行支撑，用于修复这种罕见的小儿疾病。
我们报告连续3例小儿股疝病例，仅通过两个小切口进行修复：一个5毫米的脐部切口用于置入30°摄像头，一个1厘米的腹股沟切口用于分离和结扎疝囊。结扎疝囊后，用一个小的网状卷烟进行支撑修复。
采用这种方法，3例8至9岁儿童的右侧股疝均顺利修复，无并发症发生。2例患者同侧存在间接腹股沟疝。所有患者均未发现对侧腹股沟疝。手术时间平均为40分钟，恢复时间快，6个月的随访显示美容效果良好。
这种采用小网状补片的腹腔镜辅助小儿股疝修复方法是一种安全、有效且高效的技术。由于仅需两个切口，术后疼痛极小，美容效果极佳。尽管如此，仍需要更多患者和更长时间的随访来准确判断这种新技术的长期影响。
