Bertozzi M, Magrini E, Appignani A
S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Loc. S. Andrea delle Fratte, 06100, Perugia, Italy,
Hernia. 2015 Aug;19(4):617-21. doi: 10.1007/s10029-014-1271-3. Epub 2014 Jun 13.
The authors report their preliminary experience in laparoscopic repair of associated inguinal and umbilical hernias in children.
Twenty-six patients affected by the association of inguinal and umbilical hernia with an umbilical defect larger than 5 mm underwent a laparoscopic procedure. A 5-mm trocar was placed through the umbilical defect for the optic. To fix the trocar to avoid loss of carboperitoneum, we fashioned and tightened a purse-string non-absorbable suture with a sliding knot around the defect. In this manner, we ensured the trocar, fixing it and avoiding any loss of CO2, proceeding safely to the laparoscopic IH repair, by means of two additional 3 mm operative trocars. At the end of the inguinal herniorrhaphy, the previously fashioned purse-string suture was tightened to repair the umbilical defect.
The mean operative time for the repair of associated inguinal and umbilical hernias was 30.1 ± 7.4 min in cases of unilateral inguinal hernia and 39.5 ± 10.6 for bilateral inguinal hernia. Follow-up ranged from 8 to 32 months. Neither intra- nor post-operative complications nor recurrences were seen.
This small sample suggests that this simple method is safe, effective and might be useful for pediatric surgeons performing laparoscopic repair for inguinal hernia in presence of an associated UH with a statistically significant decrease of operative time.
作者报告他们在儿童腹腔镜修复腹股沟疝和脐疝合并症方面的初步经验。
26例腹股沟疝和脐疝合并且脐部缺损大于5毫米的患儿接受了腹腔镜手术。通过脐部缺损置入一个5毫米的套管用于观察。为固定套管以避免气腹丧失,我们在缺损周围制作并收紧了一个带滑动结的荷包不可吸收缝线。通过这种方式,我们确保了套管的固定,避免了二氧化碳的任何泄漏,通过另外两个3毫米的手术套管安全地进行腹腔镜腹股沟疝修补术。在腹股沟疝修补术结束时,收紧先前制作的荷包缝线以修复脐部缺损。
单侧腹股沟疝合并脐疝修补术的平均手术时间为30.1±7.4分钟,双侧腹股沟疝合并脐疝修补术的平均手术时间为39.5±10.6分钟。随访时间为8至32个月。未观察到术中或术后并发症及复发情况。
这个小样本表明,这种简单方法是安全、有效的,对于为伴有脐疝的腹股沟疝进行腹腔镜修补术的小儿外科医生可能有用,且手术时间有统计学意义的显著缩短。