Abd-Alrazek Mohamed, Alsherbiny Hatem, Mahfouz Mohamad, Alsamahy Omar, Shalaby Rafik, Shams Abdelmoniem, Elian Ahmed, Ashour Yasser
Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt.
Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt.
J Pediatr Surg. 2017 Oct;52(10):1539-1544. doi: 10.1016/j.jpedsurg.2017.07.003. Epub 2017 Jul 13.
Inguinal hernia repair is one of the most frequently performed surgical procedure in infants and young children. Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in pediatrics. The aim of the study is to compare laparoscopic intracorporeal purse-string suture ligation of the hernia defect leaving the sac intact versus disconnection of the hernia sac with intracorporeal suturing of proximal part.
A prospective controlled randomized study of laparoscopic repair of congenital inguinal hernia (CIH) was conducted over a period of 2years and 8months from April 2014 to December 2016. All patients were randomized into two equal groups: Group I (n=66) received intracorporeal purse string suture ligation of the hernia sac at internal inguinal ring [IIR] leaving the sac intact; and Group II (n=66) received disconnection of the hernia sac with intracorporeal suture of proximal part at IIR.
Male patient with bilateral CIH, questionable other side, cases of CIH associated with umbilical hernia and parental request.
Recurrent cases, complicated cases, hernia of canal of Nuck in females, inguinal hernia with undescended testis, parental refusal. The main outcome measurements were operative time, postoperative hydrocele formation, recurrence rate.
This study included 132 patients with 157 hernia defects. Their age ranged from 6months to 3years. Statistically significant differences regarding the demographic data of the groups. All cases were completed successfully without conversion. There was no statistically significant difference between groups regarding intraoperative complications and hospital stay. There was statistically significant difference in the operative time and post-operative complications between the studied groups.
Laparoscopic inguinal hernia repair by disconnection of the hernia sac at the IIR with peritoneal closure is safe and feasible method. It has a lower recurrence rate than the purse string suturing leaving the sac intact.
腹股沟疝修补术是婴幼儿最常施行的外科手术之一。婴幼儿及儿童腹腔镜疝修补术仍存在争议。儿科腹腔镜疝修补术有多种技术可供选择。本研究的目的是比较腹腔镜下疝缺损体内荷包缝合结扎且保留疝囊完整与疝囊离断并近端体内缝合两种方法。
2014年4月至2016年12月期间，对先天性腹股沟疝（CIH）的腹腔镜修补术进行了一项前瞻性对照随机研究。所有患者被随机分为两组，每组人数相等：第一组（n = 66）在腹股沟内环（IIR）处对疝囊进行体内荷包缝合结扎，保留疝囊完整；第二组（n = 66）在IIR处离断疝囊并对近端进行体内缝合。
双侧CIH男性患者、对侧情况可疑、CIH合并脐疝的病例以及家长要求。
复发病例、复杂病例、女性Nuck管疝、腹股沟疝合并隐睾、家长拒绝。主要观察指标为手术时间、术后鞘膜积液形成情况、复发率。
本研究纳入132例患者，共157个疝缺损。年龄范围为6个月至3岁。两组的人口统计学数据存在统计学显著差异。所有病例均成功完成，无中转开腹情况。两组在术中并发症和住院时间方面无统计学显著差异。研究组之间在手术时间和术后并发症方面存在统计学显著差异。
在IIR处离断疝囊并关闭腹膜的腹腔镜腹股沟疝修补术是一种安全可行的方法。其复发率低于保留疝囊完整的荷包缝合术。
