Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan.
Pediatr Surg Int. 2022 Mar;38(3):359-363. doi: 10.1007/s00383-021-05060-4. Epub 2022 Jan 8.
Laparoscopic repairs for children with inguinal hernia have been established with various technical modifications. Laparoscopic percutaneous extraperitoneal closure (LPEC) is one of the most recognized techniques. Although the rate of complications of LPEC is similar to conventional repairs, the major cause of recurrence is still incompletely understood. The purpose of this study is to evaluate detail profile of the cause of recurrence in children treated with LPEC.
A systematic literature search was performed using the combinations of the following terms "pediatric inguinal hernia", "LPEC", "complication", and "recurrence" for studies published between 2002 and 2020. The relevant cohorts of recurrence of LPEC in children were systematically searched for clinical outcomes.
35 studies met defined inclusion criteria, reporting a total of 121 patients who had recurrence after LPEC. The mean age at primary operations was 46.7 ± 52.0 months. The gender proportions were 63.9% (male) and 36.1% (female). The rate of treatment side was 44.5% (right), 37.0% (left) and 18.5% (bilateral). The hernia sac was closed with absorbable suture materials (5.3%) and non-absorbable (94.7%). The recurrence occurred in 6.9 ± 8.5 months postoperatively. Operative findings of reoperation were loosening of the knot of internal rings (61.1%), low ligation of the inguinal canal (16.7%), and skipping (22.2%).
This study suggests that male infants have a higher risk of recurrence after LPEC, and the majority of recurrences can occur in a year postoperatively. It is important to confirm carefully that the suture is tight and high without skipping.
腹腔镜技术已被广泛应用于小儿腹股沟疝的治疗，并在此基础上进行了多种技术改良。腹腔镜经皮腹膜外疝修补术（LPEC）是其中一种较为公认的技术。虽然 LPEC 的并发症发生率与传统手术相似，但复发的主要原因仍不完全清楚。本研究旨在评估 LPEC 治疗儿童腹股沟疝复发的详细原因。
通过组合使用以下术语进行系统文献检索：“小儿腹股沟疝”、“LPEC”、“并发症”和“复发”，检索 2002 年至 2020 年发表的文献。系统搜索 LPEC 治疗儿童腹股沟疝复发的相关队列，以获取临床结局。
符合纳入标准的 35 项研究报告了 121 例 LPEC 后复发的患儿。初次手术时的平均年龄为 46.7±52.0 个月。患儿性别比例为 63.9%（男）和 36.1%（女）。治疗侧别比例为 44.5%（右侧）、37.0%（左侧）和 18.5%（双侧）。疝囊用可吸收缝线（5.3%）和不可吸收缝线（94.7%）关闭。复发发生在术后 6.9±8.5 个月。再次手术时的手术发现包括内环结扎线松动（61.1%）、腹股沟管低位结扎（16.7%）和滑脱（22.2%）。
本研究表明，男性婴儿 LPEC 后复发风险较高，大多数复发可在术后 1 年内发生。重要的是要仔细确认缝线无松动和滑脱，且位置较高。
