Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea.
Surg Endosc. 2022 Jun;36(6):4321-4327. doi: 10.1007/s00464-021-08776-5. Epub 2021 Oct 25.
Congenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH). However, in some patients, PIH occurs via acquired defects rather than congenital defects. The most representative cause of PIH is recurrent hernia. Recurrent PIH is treated with high ligation (HL), which is the same method that is used to treat primary PIH. However, the re-recurrence rate of recurrent PIH is high. This study aimed to compare laparoscopic iliopubic tract repair (IPTR) with laparoscopic HL for the treatment of recurrent PIH after primary PIH repair.
From June 2013 to March 2019, 126 patients (< 10 years old) with recurrent PIH were retrospectively enrolled. Patients were divided into two groups according to the operative technique: laparoscopic HL (58 patients) and laparoscopic IPTR (68 patients). With HL, the hernial sac was removed and the peritoneum closed. With IPTR, iliopubic tract and transversalis fascia sutures were applied.
There were no cases of conversion to open surgery. Re-recurrence only occurred in the HL group; no patients in the IPTR group developed re-recurrence (8.6% [5/58] vs. 0.0% [0/68], respectively; p = 0.044). The mean duration from re-operation to re-recurrence in these five patients was 10.6 months. Other surgical outcomes and complications did not differ between the two groups.
Laparoscopic IPTR is an effective surgical treatment for reducing re-recurrence of recurrent PIH.
先天性缺陷，如开放的鞘状突和努克管，是小儿腹股沟疝（PIH）的常见原因。然而，在一些患者中，PIH 是通过后天性缺陷而不是先天性缺陷引起的。PIH 最具代表性的原因是复发性疝。复发性 PIH 采用高位结扎（HL）治疗，这与治疗原发性 PIH 的方法相同。然而，复发性 PIH 的再复发率较高。本研究旨在比较腹腔镜髂腹股沟管修复（IPTR）与腹腔镜 HL 治疗原发性 PIH 修复后复发性 PIH。
从 2013 年 6 月至 2019 年 3 月，回顾性纳入 126 例（<10 岁）复发性 PIH 患者。根据手术技术将患者分为两组：腹腔镜 HL 组（58 例）和腹腔镜 IPTR 组（68 例）。在 HL 中，切除疝囊并关闭腹膜。在 IPTR 中，应用髂腹股沟管和横筋膜缝线。
无中转开放手术病例。仅 HL 组发生再复发；IPTR 组无患者再复发（8.6%[5/58]与 0.0%[0/68]，分别；p=0.044）。这 5 例患者再手术至再复发的平均时间为 10.6 个月。两组的其他手术结果和并发症无差异。
腹腔镜 IPTR 是降低复发性 PIH 再复发的有效手术治疗方法。
