Great Ormond Street Hospital for Children, London, UK.
Surgery Unit, DBC, NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.
Pediatr Surg Int. 2023 Dec 8;40(1):17. doi: 10.1007/s00383-023-05599-4.
To review our experience of laparoscopic inguinal hernia repair (LIHR) regarding complication rates, the practice of closing the asymptomatic patent processes vaginalis (PPV), and comparison of complication rates between pre-term (< 37 week gestation) and term infants.
Retrospective review of LIHR performed between 2009 and 2021. Repair was performed by intracorporal single or double purse string/purse string + Z-stitch using a non-absorbable suture. Data were analyzed using Chi-squared/Mann-Whitney and are quoted as median (range).
1855 inguinal rings were closed in 1195 patients (943 (79%) male). 1378 rings (74%) were symptomatic. 492 (41%) patients were pre-term. Corrected gestational age at surgery was 55 weeks (31 weeks-14.6 years) and weight 5.9 kg (1-65.5). Closure of contralateral PPV was higher in the premature group (210/397 [53%] vs. 265/613 [43%] p = 0.003). There were 23 recurrences in 20 patients, of whom 10 had been born prematurely. The only factor significantly associated with a lower recurrence was use of a second stitch (p = 0.011).
This is the largest single-center reported series of LIHR. LIHR is safe at any age, the risk of recurrence is low, and can be corrected by re-laparoscopy. Use of a Z-stitch or second purse string is associated with a significantly lower rate of recurrence.
回顾我们在腹腔镜腹股沟疝修补术（LIHR）方面的经验，包括并发症发生率、无症状的鞘状突未闭（PPV）的闭合实践，以及早产儿（<37 周妊娠）和足月婴儿之间的并发症发生率比较。
回顾性分析 2009 年至 2021 年间进行的 LIHR。采用腔内单或双荷包/荷包+Z 形缝合线（不可吸收缝线）进行修复。使用卡方检验/Mann-Whitney 进行数据分析，并以中位数（范围）表示。
在 1195 名患者中，1855 个腹股沟环被闭合（943 名男性[79%]）。1378 个环（74%）为有症状。492 名患者（41%）为早产儿。手术时的矫正胎龄为 55 周（31 周至 14.6 岁），体重 5.9 公斤（1-65.5 公斤）。在早产儿组，对侧 PPV 的闭合率更高（210/397 [53%]比 265/613 [43%]，p=0.003）。在 20 名患者中有 23 例复发，其中 10 名出生时为早产儿。唯一与复发率降低显著相关的因素是使用第二根缝线（p=0.011）。
这是最大的单中心报告的 LIHR 系列。LIHR 在任何年龄都是安全的，复发风险低，可以通过再次腹腔镜手术纠正。使用 Z 形缝合或第二根荷包缝线与复发率显著降低相关。
