Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China.
Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China.
Hernia. 2020 Oct;24(5):1099-1105. doi: 10.1007/s10029-020-02180-z. Epub 2020 Apr 7.
Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17 years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy.
From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed.
All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15 min (8-25 min) for 557 unilateral hernias and 21 min (14-36 min) for 233 bilateral hernias. The mean postoperative stay was 20 h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42 months. No obvious scar was present postoperatively.
Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.
腹腔镜内环高位结扎术是小儿腹股沟疝（PIH）治疗的一种替代方法，其主要趋势是越来越多地使用体外打结和减少使用工作端口。我们已经使用这种腹腔镜技术治疗了 PIH 的整个范围（包括嵌顿病例）超过 17 年，并且该技术不断发展和改进。在此，我们报告了这种微创技术的最新改良，即使用普通锥形针进行单部位腹腔镜经皮腹膜外疝囊高位结扎术（SLPEC），并评估其安全性和疗效。
自 2016 年 7 月至 2019 年 7 月，采用腹腔镜手术治疗 790 例间接 PIH 患儿。所有患者均行高位结扎术，改良的单部位腹腔镜技术主要采用普通闭合眼锥形针（1/2 弧 11×34）进行体外缝合。回顾性分析临床资料。
所有手术均成功完成，无严重并发症。术中发现对侧未闭鞘突（CPPV），并随后对 190 例患者（25.4%）进行了修复。557 例单侧疝的平均手术时间为 15 分钟（8-25 分钟），233 例双侧疝的平均手术时间为 21 分钟（14-36 分钟）。平均术后住院时间为 20 小时。5 例（0.63%）患者出现轻微并发症，经适当处理，对最终结果无重大影响。随访 6-42 个月，患者无复发。术后无明显瘢痕。
使用普通锥形针改良 SLPEC 行疝囊高位结扎术治疗间接 PIH 是一种安全、可靠、微创的方法，具有满意的效果，无需特殊器械。操作简单易学，值得在临床推广。
