Shalaby Rafik, Ismail Maged, Samaha Abdelhady, Yehya Abdelaziz, Ibrahem Refaat, Gouda Samir, Helal Ahmed, Alsamahy Omar
Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
J Pediatr Surg. 2014 Mar;49(3):460-4. doi: 10.1016/j.jpedsurg.2013.10.019. Epub 2013 Nov 9.
Laparoscopic inguinal hernia repair (LIHR) in children has become an alternative to the open procedure. It is gaining popularity with more and more studies supporting its feasibility, safety, and efficacy. This is a retrospective study to present our experience with children who underwent LIHR.
A total of 1184 inguinal hernias were repaired laparoscopically in 874 children. They were 703 boys and 171 girls. Their mean age was 2.9 ± 2.1 years (range, 6-108 months). Six-hundred and twenty four opened internal inguinal rings (IIRs) were closed by transperitoneal purse string suture technique (TPP) and 560 opened IIRs were closed by percutaneous purse string suture with lateral umbilical ligament enforcement using Reverdin Needle (RN) technique.
All cases were completed laparoscopically without conversion. There were no serious intraoperative complications. Mean operating time, in TPP technique, was 15 ± 2.3 minutes for unilateral and 20 ± 1.7 minutes for bilateral inguinal hernia, while the mean operating time, in RN technique, was 8.7 ± 1.18 minutes for unilateral and 12.35 ± 2 minutes for bilateral hernia repair. The contralateral patent processus vaginalis (PPV) was present in 176 (20% of cases). Follow-up to date is 10-140 months (mean 80 ± 2.1 months). In the early stage of this study, the recurrence rate was 1.13%. In the last 450 cases, no recurrence occurred. Hydroceles occurred in 0.58% and no testicular atrophy or iatrogenic ascent of the testis.
LIHR can be a routine procedure with results comparable to those of open procedures. Both recurrence and operative time are nearly equal or even less than that for the open procedure after gaining a learning curve and modifications of the techniques.
小儿腹腔镜腹股沟疝修补术（LIHR）已成为开放手术的替代方法。随着越来越多的研究支持其可行性、安全性和有效性，该手术越来越受欢迎。这是一项回顾性研究，旨在介绍我们对接受LIHR的儿童的经验。
874例儿童共1184例腹股沟疝接受了腹腔镜修补术。其中男孩703例，女孩171例。他们的平均年龄为2.9±2.1岁（范围6 - 108个月）。624个开放的腹股沟内环（IIR）采用经腹荷包缝合技术（TPP）关闭，560个开放的IIR采用使用Reverdin针（RN）技术经皮荷包缝合并加强外侧脐韧带关闭。
所有病例均在腹腔镜下完成，无中转开腹。术中无严重并发症。TPP技术中，单侧腹股沟疝平均手术时间为15±2.3分钟，双侧腹股沟疝为20±1.7分钟；而RN技术中，单侧疝修补平均手术时间为8.7±1.18分钟，双侧疝修补为12.35±2分钟。对侧鞘状突未闭（PPV）在176例（20%的病例）中存在。随访时间为10 - 140个月（平均80±2.1个月）。在本研究早期，复发率为1.13%。在最后450例中，无复发发生。鞘膜积液发生率为0.58%，无睾丸萎缩或医源性睾丸上升。
LIHR可以作为一种常规手术，其结果与开放手术相当。在获得学习曲线并改进技术后，复发率和手术时间几乎与开放手术相等，甚至更低。
