1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece; Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece.
1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece.
J Pediatr Urol. 2019 Apr;15(2):185.e1-185.e5. doi: 10.1016/j.jpurol.2018.12.007. Epub 2019 Jan 4.
An open internal inguinal ring (IIR) may be discovered incidentally either in the context of correcting pathology involving the contralateral side or at the time of surgical exploration for reasons unrelated to a patent processus vaginalis (PPV). The aim of this study is to determine the evolution of an incidentally encountered open IIR in patients undergoing laparoscopy for reasons not associated with unilateral inguinal hernia or cryptorchidism.
The authors conducted a prospective study of all patients who underwent laparoscopic surgery in the department of pediatric surgery at Agios Loukas hospital between 2004 and 2013 for various indications. Patients operated for inguinal hernia and cryptorchidism were excluded. During this period, 572 patients underwent laparoscopy for reasons not related to PPV. The median age at time of initial laparoscopy was 9,4 years (range 2 days-16 years). The IIRs were always inspected. No attempt was made to repair the open IIRs, as they were asymptomatic. Parents were informed after the operation, and instructions were given to inform us, in case that inguinal hernia symptoms manifested. The duration of the follow-up was 4 years.
Among these 572 patients, 39 patients with 44 open IIRs were found (6,82%). From the 39 patients, 35 were male and four were female; 22 had a right open IIR, 12 had a left one, and five of them a bilateral open IIR. The median age was 7,82 years (3-14 years). Four patients were lost during follow-up. Of the remaining 35 patients with 40 open IIRs, four developed an inguinal hernia (11,43%) and were operated on with laparoscopically assisted (subcutaneous endoscopically assisted ligation [SEAL]) technique at the time of diagnosis. The study results are demonstrated on Fig. 1.
The percentage of an incidentally discovered open IIR in this study is lower in comparison with studies including patients with PPV pathologies. There is a possibility, in those patients, of underlying pathology which can affect both sides. It is also lower in comparison with previous studies including younger patients. However, gender and side predominance is in accordance with most published studies. In this study group, the possibility of developing a symptomatic hernia from an asymptomatic open IIR is rather small.
An incidentally discovered open IIR in patients without symptoms, excluding those with contralateral inguinal hernias or cryptorchidism, has relatively low chance of developing an inguinal hernia. Thus, the authors support the strategy of close follow-up in these patients.
在纠正对侧病变或在与未闭鞘突无关的手术探查时，偶然发现开放的内环（IIR）。本研究的目的是确定在因单侧腹股沟疝或隐睾以外的原因接受腹腔镜手术的患者中，偶然发现的开放 IIR 的演变情况。
作者对 2004 年至 2013 年间在圣卢卡斯医院小儿外科接受腹腔镜手术的所有患者进行了前瞻性研究，手术原因各不相同。排除了因腹股沟疝和隐睾而接受手术的患者。在此期间，有 572 例患者因与未闭鞘突无关的原因接受了腹腔镜手术。首次腹腔镜检查时的中位年龄为 9.4 岁（范围 2 天-16 岁）。IIR 始终进行检查。由于无症状，未尝试修复开放的 IIR。术后告知家长，并嘱其如有腹股沟疝症状出现，及时通知我们。随访时间为 4 年。
在这 572 例患者中，发现 39 例患者（6.82%）有 44 个开放的 IIR。这 39 例患者中，男 35 例，女 4 例；右侧开放 IIR22 例，左侧 12 例，双侧 5 例。中位年龄为 7.82 岁（3-14 岁）。4 例患者在随访期间失访。在其余 35 例有 40 个开放的 IIR 的患者中，有 4 例（11.43%）出现腹股沟疝，并在诊断时通过腹腔镜辅助（皮下内镜辅助结扎术 [SEAL]）技术进行了手术。研究结果如图 1 所示。
与包括有未闭鞘突病变的患者的研究相比，本研究中偶然发现的开放 IIR 的百分比较低。在这些患者中，存在可能影响两侧的潜在病理。与包括年龄较小患者的先前研究相比，该百分比也较低。然而，性别和侧别优势与大多数已发表的研究一致。在本研究组中，无症状的开放 IIR 发展为有症状疝的可能性较小。
对于无症状的患者，排除对侧腹股沟疝或隐睾的患者，偶然发现的开放 IIR 发展为腹股沟疝的可能性相对较低。因此，作者支持对这些患者进行密切随访的策略。
