Al-Azhar University Hospital, Cairo, Egypt.
Al-Azhar University Hospital, Cairo, Egypt.
J Pediatr Surg. 2019 Jul;54(7):1505-1509. doi: 10.1016/j.jpedsurg.2019.01.054. Epub 2019 Feb 18.
The desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine.
The first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate.
The sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ± 1.2 months.
The closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.
为了减少切口相关的发病率和疼痛，同时获得良好的美容效果，小儿外科医生最近引入了单切口小儿内镜手术[SIPES]和针式手术。在 SIPES 中进行腔内缝合和打结仍然具有挑战性。本研究的目的是介绍一种新的简单技术，用于在针式分离疝囊后，通过仅使用针而不是腹腔镜器械对小儿腹股沟疝进行腔内缝合。这是对缝纫机原理的模仿。
第一作者与合著者讨论了该技术的想法，并在硅垫上进行了演示，然后将该技术应用于先天性腹股沟疝[CIH]儿童，用于在针式分离疝囊后关闭腹膜。主要观察指标是技术的可行性、缝合和打结时间以及复发率。
在所有实验中，缝线都紧密地应用于硅垫的脊上，并且在所有实验中都紧密地收紧了结。在硅垫上应用和掌握该技术后，我们将其转移到 373 名儿童的 491 例疝缺损中使用。所有手术均通过针式技术完成，无需插入任何腹腔镜器械。缝合内环周围腹膜和打结所需的时间明显减少，从第 1 次手术的 6 分 27 秒减少到第 5 次手术后的不到 4 分钟，并稳定在大约 4 分 30 秒。没有出现重大的术中并发症。在平均 19.6±1.2 个月的随访期间，没有复发。
用针模拟缝纫机缝合的方式缝合内环周围的腹膜是治疗 CIH 儿童的一种可行、安全、有效的方法。美容效果非常出色，没有任何复发。
