Department of Urology, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, No. 966 Hengyu Road, Fuzhou, 350000, China.
Sci Rep. 2024 Jul 4;14(1):15389. doi: 10.1038/s41598-024-60476-x.
The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children's Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.
目的 探讨使用双改良疝针注水分离行单孔腹腔镜经腹腹膜前疝修补术（SLPEC 组）和两孔腹腔镜经腹腹膜前疝修补术（TLPEC 组）治疗儿童巨大腹股沟斜疝的疗效。我们回顾性分析了 2019 年 1 月至 2021 年 12 月在福建医科大学附属福建省儿童医院行腹腔镜疝囊高位结扎术的所有巨大腹股沟斜疝（内环口直径≥1.5cm）患儿的临床资料。收集所有患儿的病历资料，分析其临床特征、手术相关资料及随访情况。本研究共纳入 219 例孤立性巨大腹股沟疝患儿，均有完整的临床资料，且在本中心行腹腔镜疝囊高位结扎术。106 例行 SLPEC 术和 113 例行 TLPEC 术的患儿均顺利完成手术。两组患儿的年龄、性别、体质量、随访时间、疝侧别差异均无统计学意义（P=0.123、0.613、0.121、0.076、0.081）。但两组患儿的术中出血量、视觉模拟评分（VAS）评分、术后活动时间比较，差异均有统计学意义（P≤0.001）。TLPEC 组手术时间长于 SLPEC 组（P=0.048），但两组患儿的住院时间、住院费用比较，差异均无统计学意义（P=0.244、0.073）。SLPEC 组有 2 例患儿和 TLPEC 组有 9 例患儿的切口瘢痕可见，两组比较，差异有统计学意义（P=0.04）。但两组患儿的同侧疝复发、手术部位感染、缝线结反应、慢性腹股沟痛发生率比较，差异均无统计学意义（P=0.332、0.301、0.332、0.599）。SLPEC 组有 1 例男性患儿术后出现阴囊积液，TLPEC 组无男性患儿出现阴囊积液，两组比较，差异无统计学意义（P=0.310）。两组患儿均无睾丸萎缩和医源性睾丸上移发生。与 TLPEC 组比较，SLPEC 组具有切口隐匿、瘢痕小、微创、手术时间短、出血量少、疼痛轻、恢复快等优点。结论 注水分离双改良疝针行单孔腹腔镜经腹腹膜前疝修补术联合疝囊高位结扎术治疗儿童巨大腹股沟斜疝安全、有效、微创，美容效果满意，随访结果良好。
