Department of Pediatric Surgery, Fujian Medical University Union Hospital, China.
Department of Pediatric Surgery, Fujian Medical University Union Hospital, China.
Asian J Surg. 2024 Jan;47(1):134-139. doi: 10.1016/j.asjsur.2023.05.013. Epub 2023 May 22.
Although the laparoscopic treatment of pediatric inguinal hernia (PIH) has more benefits than traditional surgery, it is difficult to completely avoid the problem of recurrence. The aim of this study was to use a logistic regression model to investigate the causes of recurrence after laparoscopic percutaneous extraperitoneal repair (LPER) of PIH.
From June 2017 to December 2021, 486 cases of PIH were performed using LPER in our department. We utilized a two-port approach to implement LPER for PIH. All cases were followed up and the recurrent cases were recorded in detail. We used a logistic regression model to analyze the clinical data in order to find the reasons for recurrence.
We completed 486 cases with an internal inguinal ostium high ligation using laparoscopic surgery without conversion. Patients were followed for 10-29 months with an average of 18.2 months and 8 cases had recurrent ipsilateral hernia, including 4 recurrent cases in 89 cases (4.49%) using absorbable suture, 1 in 7 cases (14.29%) with internal inguinal ostium larger than 25 mm, 2 in 26 cases (7.69%) with BMI greater than 21, 2 in 41 cases (4.88%) with postoperative chronic constipation. The total recurrence rate was 1.65%. A foreign body reaction occurred in 2 cases, there were no complications such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, and no deaths in this study. Univariate logistic regression analysis showed that patient BMI, ligation suture, diameter of the internal inguinal ostium and postoperative chronic constipation were significant variables (P values 0.093, 0.027, 0.060 and 0.081). The multivariate logistic regression analysis showed that the ligation suture and the diameter of the internal inguinal ostium were the main risk factors for postoperative recurrence, the odds ratio (OR) value were 5.374 and 2.801, the P values 0.018 and 0.046, and the 95% CI were 2.513-11.642 and 1.134-9.125. The area under ROC curve (AUC) for the logistic regression model was 0.735 (the 95% CI 0.677-0.801, P < 0.01).
An LPER for PIH is a safe and effective operation, but there still remains a small probability of recurrence. In order to reduce the recurrence rate of LPER, we should improve surgical skills, choose an appropriate ligature and avoid using LPER for a huge internal inguinal ostium (especially over 25 mm). It is appropriate to be converted to open surgery for the patients with a very wide internal inguinal ostium.
尽管腹腔镜治疗小儿腹股沟疝（PIH）比传统手术有更多的优势，但仍难以完全避免复发的问题。本研究旨在使用逻辑回归模型探讨腹腔镜经皮腹膜外修补术（LPER）治疗 PIH 后复发的原因。
自 2017 年 6 月至 2021 年 12 月，我科采用 LPER 治疗 486 例 PIH。我们采用两孔法行 LPER 治疗 PIH。所有病例均随访，详细记录复发病例。我们使用逻辑回归模型分析临床资料，以寻找复发的原因。
我们完成了 486 例腹腔镜高位内环口结扎术，无中转开腹。患者平均随访 10-29 个月，平均 18.2 个月，8 例出现同侧疝复发，其中 4 例（4.49%）使用可吸收缝线，1 例（14.29%）内环口直径>25mm，2 例（7.69%）BMI>21，2 例（4.88%）术后慢性便秘。总的复发率为 1.65%。2 例发生异物反应，无阴囊血肿、脐孔疝、睾丸萎缩等并发症，无死亡病例。单因素 logistic 回归分析显示，患者 BMI、结扎缝线、内环口直径和术后慢性便秘是显著变量（P 值分别为 0.093、0.027、0.060 和 0.081）。多因素 logistic 回归分析显示，结扎缝线和内环口直径是术后复发的主要危险因素，比值比（OR）值分别为 5.374 和 2.801，P 值分别为 0.018 和 0.046，95%CI 分别为 2.513-11.642 和 1.134-9.125。logistic 回归模型的 ROC 曲线下面积（AUC）为 0.735（95%CI 0.677-0.801，P<0.01）。
LPER 治疗 PIH 是一种安全有效的手术，但仍有小概率复发。为降低 LPER 复发率，应提高手术技巧，选择合适的结扎缝线，避免对过大的内环口（尤其是>25mm）行 LPER，对于内环口非常宽的患者应转为开放手术。
