Lee S R, Choi S B
Department of Surgery, Damsoyu Hospital, Central Tower 5-9F, Bongeunsa-ro 213, Gangnam-gu, Seoul, South Korea.
Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80, Guro-dong, Guro-gu, Seoul, South Korea.
Hernia. 2017 Jun;21(3):425-433. doi: 10.1007/s10029-016-1546-y. Epub 2016 Nov 19.
Pediatric laparoscopic herniorrhaphy has rare complications, but recurrence might occur. The purpose of this manuscript is to evaluate the efficacy of linear suture technique of laparoscopic pediatric herniorrhaphy in reducing recurrences.
Laparoscopic surgery was performed on 2223 pediatric patients (under 10 years old) from September 2012 to December 2014 in Damsoyu Hospital, Seoul, Republic of Korea. The causes of recurrence were investigated case by case. The patients were categorized into two groups according to the suture method used in closing the hernia orifice: Group 1 (purse-string suture, 1009 patients) and Group 2 (linear suture, 1214 patients).
There were 1413 (63.6%) male and 810 (36.4%) female patients. Mean age was 30.5 ± 29.2 months. A significantly higher proportion of male patients, contralateral patent processus vaginalis, and less proportion of recurrence were observed in Group 2. There were ten cases of recurrence in Group 1 because the internal ring suture could not endure the tension. One recurrence occurred in Group 2. The suture technique and age were found to be a significant risk factor for recurrence. Linear suture technique had a lower recurrence rate (odds ratio = 0.07, with 95% confidence interval 0.01-0.53, and p = 0.004).
Purse-string suture technique causes significantly higher occurrence of hernia recurrences than linear suture technique. Linear suture technique can reduce recurrence by increasing the endurance to tension around the internal ring by distributing pressure to a wider area along the linear suture line. Linear suture technique can effectively reduce recurrence in pediatric inguinal herniorrhaphy.
小儿腹腔镜疝修补术并发症罕见，但仍可能复发。本文旨在评估小儿腹腔镜疝修补术的线性缝合技术在减少复发方面的疗效。
2012年9月至2014年12月，对韩国首尔Damsoyu医院的2223例10岁以下小儿患者进行了腹腔镜手术。逐例调查复发原因。根据关闭疝孔时使用的缝合方法将患者分为两组：第1组（荷包缝合，1009例患者）和第2组（线性缝合，1214例患者）。
男性患者1413例（63.6%），女性患者810例（36.4%）。平均年龄为30.5±29.2个月。第2组男性患者比例显著更高，对侧鞘状突未闭，复发比例更低。第1组有10例复发是因为内环缝合无法承受张力。第2组有1例复发。发现缝合技术和年龄是复发的重要危险因素。线性缝合技术的复发率较低（优势比=0.07，95%置信区间为0.01-0.53，p=0.004）。
荷包缝合技术导致疝复发的发生率显著高于线性缝合技术。线性缝合技术可通过沿线性缝合线将压力分布到更广泛区域，增加内环周围对张力的耐受性，从而减少复发。线性缝合技术可有效降低小儿腹股沟疝修补术的复发率。
