Shalaby Rafik, Ismail Maged, Shehata Sameh, Gamaan Ibrahim, Yehya Abdelaziz, Elsayaad Ibrahim, Akl Mabrouk, Shams Abdelmonaem
Pediatric Surgery Department, Al-Azhar University.
Pediatric Surgery Department, Al-Azhar University.
J Pediatr Surg. 2015 Nov;50(11):1995-2000. doi: 10.1016/j.jpedsurg.2015.07.019. Epub 2015 Aug 7.
The desire to reduce incision related morbidity and pain while achieving improve cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES]. Over the last few years, SIPES has been increasingly used for a variety of procedures; single incision laparoscopic hernia repair [SILHR] is perhaps its common application. Intracorporeal suturing and knot tying during SIPES remain one of the most challenging tasks. The aim of this study is to present a novel technique to avoid excessive purposeless movements during SILHR in children.
One-hundred and fifty patients with 170 hernial defects were subjected to SILHR during the period from June 2009 to October 2011. Extraperitoneal saline was injected around internal inguinal ring [IIR] in males. The opened IIR was closed by percutaneous insertion of purse string suture using Reverdin Needle (RN) with intracorporeal suture tie. The main outcome measurements were; feasibility of the technique, tightness of the suture tie, operative time, postoperative hydrocele formation, recurrence rate, and cosmetic results.
Ages ranged between 6 months and 7 years (mean 2±24.2years). There were 101 males and 49 females. Eighty-four patients presented with right sided inguinal hernia, 46 patients with left sided hernia, and 20 patients with bilateral hernia. The mean operative time was 12.4±1.7min for unilateral cases and 18.6±1.7min for the bilateral cases. On follow-up, there were only 1 case of recurrence and 3 cases of hydrocele and the scar is nearly invisible.
The preliminary results of this study showed that our technique is very promising to achieve secure closure of IIR and reduced operative time with excellent cosmetic results.
在追求减少切口相关并发症和疼痛并获得更好美容效果的需求推动下，近年来出现了单切口小儿内镜手术[SIPES]。在过去几年中，SIPES已越来越多地用于各种手术；单切口腹腔镜疝修补术[SILHR]可能是其最常见的应用。SIPES手术中的体内缝合和打结仍然是最具挑战性的任务之一。本研究的目的是提出一种新技术，以避免小儿SILHR手术中过多的无目的动作。
2009年6月至2011年10月期间，150例患者共170处疝缺损接受了SILHR手术。男性患者在腹股沟内环[IIR]周围注射腹膜外生理盐水。使用Reverdin针（RN）经皮插入荷包缝合线并在体内打结，关闭开放的IIR。主要观察指标包括：该技术的可行性、缝线打结的紧密度、手术时间、术后鞘膜积液形成情况、复发率和美容效果。
年龄范围在6个月至7岁之间（平均2±24.2岁）。男性101例，女性49例。84例患者为右侧腹股沟疝，46例为左侧疝，20例为双侧疝。单侧病例的平均手术时间为12.4±1.7分钟，双侧病例为18.6±1.7分钟。随访发现，仅1例复发，3例鞘膜积液，瘢痕几乎不可见。
本研究的初步结果表明，我们的技术在实现IIR安全闭合、缩短手术时间并获得出色美容效果方面非常有前景。
