Helal Ahmed Abdelghaffar, Daboos Mohammad, Othman Alsayed, Abdelhafez Muhammad
Pediatric Surgery Department, Al-Azhar University, Cairo, Egypt.
Al-Houssain University Hospital, Darrasa, Cairo, Egypt.
Minim Invasive Surg. 2020 Aug 6;2020:5610513. doi: 10.1155/2020/5610513. eCollection 2020.
Single-incision percutaneous closure (SIPC) of pediatric inguinal hernia under laparoscopic guidance is a well-developed feasible technique; however, suture knotting remains a major challenge during this technique. Most laparoscopic surgeons prefer extracorporeal subcutaneous suture knotting, which may be associated with consequent formation of stitch sinus and increased recurrence rate. On the other hand, intracorporeal suture knotting necessitates the availability of special devices or homemade instruments with a long learning curve. Therefore, the present study innovates new and simple modification allowing intracorporeal suture knotting during SIPC of pediatric inguinal hernia that does not require any special operating devices or homemade instruments. . Four-hundred children suffering from inguinal hernia of congenital type, submitted to SIPC using Epidural needle (EN), under laparoscopic guidance with intracorporeal suture knotting.
Children ages were 6 months to 10 years (the range). There were 300 boys and 100 girls, and two-hundred children suffered from left side hernia, 150 with right-side hernia, and 50 children with both left- and right-side hernia. 10 ± 2.2 minutes was the recorded operation time in one side hernia repair, while 14 ± 4.3 minutes was recorded for both side repair. Postoperative results reported recurrent hernia in one child and postoperative hydrocele in 3 children which resolved spontaneously after 3 weeks of follow-up.
Intracorporeal suture knotting during SIPC of pediatric inguinal hernia allows for the transformation of a formally extraperitoneal procedure to an intraperitoneal procedure. This new modification for intracorporeal suture knotting does not require any special operating devices or homemade instruments. It seems to be an attractive way during SIPC of pediatric inguinal hernia when intracorporeal suture knotting is considered.
腹腔镜引导下小儿腹股沟疝单切口经皮闭合术（SIPC）是一种成熟可行的技术；然而，缝合打结仍是该技术中的一项重大挑战。大多数腹腔镜外科医生倾向于体外皮下缝合打结，这可能会导致缝线窦形成及复发率增加。另一方面，体内缝合打结需要特殊设备或自制器械，且学习曲线较长。因此，本研究创新了一种新的简单改良方法，可在小儿腹股沟疝SIPC过程中进行体内缝合打结，无需任何特殊手术设备或自制器械。400例先天性腹股沟疝患儿在腹腔镜引导下使用硬膜外针（EN）进行SIPC，并采用体内缝合打结。
患儿年龄在6个月至10岁之间（此为范围）。有300名男孩和100名女孩，200名患儿患有左侧疝，150名患有右侧疝，50名患儿双侧均有疝。单侧疝修补术记录的手术时间为10±2.2分钟，双侧修补术记录的手术时间为14±4.3分钟。术后结果显示，1例患儿出现复发性疝，3例患儿出现术后鞘膜积液，随访3周后自行消退。
小儿腹股沟疝SIPC过程中的体内缝合打结可使原本的腹膜外手术转变为腹膜内手术。这种新的体内缝合打结改良方法无需任何特殊手术设备或自制器械。当考虑体内缝合打结时，它似乎是小儿腹股沟疝SIPC过程中一种有吸引力的方法。
