Akin Melih, Demir Mesut, Kaba Meltem, Sever Nihat, Dokucu Ali Ihsan
Department of Pediatric Surgery, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2022 Jun 28;56(2):232-237. doi: 10.14744/SEMB.2021.59375. eCollection 2022.
Percutaneous internal ring suturing (PIRS) method for inguinal hernia (IH) repair in girls is increasingly used in clinics especially experienced in minimal invasive surgery. We aimed to evaluate and compare our results of laparoscopic PIRS and the open procedure for IH repair in girls in our series.
We retrospectively evaluated female patients in our pediatric surgery clinic who underwent IH surgery between 2012 and 2017 and results were assessed statistically.
We identified 293 girls operated in our clinic with IH. In 164 of them, PIRS procedure (group 1) was performed; 73 had right, 26 had left, and 65 (39.6%) had bilateral IH. Among these 65 patients, 16 had only right and 11 had only left IH according to preoperative examination, which turned out to be bilateral during laparoscopy. In the open surgery group (Group II), there were 129 patients. Seventy-eight patients had right, 38 had left, and 13 (10%) had bilateral IH. Sliding fallo-pian tubes were present in seven of Group I versus 21 of group II (p<0.001), while sliding ovaries were present in seven of Group I versus 16 of Group II (p=0.015). Recurrence was observed in only one patient in Group I (p>0.05).
The higher rate of bilaterality is still the problem for laparoscopic procedures. Despite over-diagnosis, no more complications were not detected due to PIRS. High ratio of sliding tubes and ovaries can be due to traction for preparing the sac in open surgery. Hematoma can be a serious problem to complete PIRS procedure. Preferred technique from the surgeon's point of view is in favor of PIRS procedure. In addition, PIRS pro-cedure can be more protective for internal genitalia, but more studies with higher numbers and longer follow-up period are needed.
经皮内环缝合术（PIRS）用于女童腹股沟疝（IH）修补术在临床中越来越常用，尤其是在微创手术经验丰富的科室。我们旨在评估和比较我们系列中女童腹腔镜PIRS和开放手术修补IH的结果。
我们回顾性评估了2012年至2017年间在我们儿科外科诊所接受IH手术的女性患者，并对结果进行了统计学评估。
我们确定了293名在我们诊所接受IH手术的女童。其中164例接受了PIRS手术（第1组）；73例为右侧，26例为左侧，6s例（39.6%）为双侧IH。在这65例患者中，根据术前检查，16例仅为右侧IH，11例仅为左侧IH，而在腹腔镜检查时发现为双侧。开放手术组（第II组）有129例患者。78例为右侧，38例为左侧，13例（10%）为双侧IH。第I组中有7例出现滑动的输卵管，而第II组中有21例（p<0.001）；第I组中有7例出现滑动的卵巢，而第II组中有16例（p=0.015）。第I组中仅1例患者出现复发（p>0.05）。
腹腔镜手术中较高的双侧发生率仍是一个问题。尽管存在过度诊断，但未发现PIRS导致更多并发症。滑动输卵管和卵巢的高比例可能是由于开放手术中为准备疝囊而进行的牵拉。血肿可能是完成PIRS手术的一个严重问题。从外科医生的角度来看，首选技术有利于PIRS手术。此外，PIRS手术对内生殖器可能更具保护作用，但需要更多数量和更长随访期的研究。
