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Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy.

Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E - Surg Endosc (2009)

Bottom Line: Mean operation times were equal for both groups for unilateral repair (28.2 +/- 9.2 for LPC vs. 27.8 +/- 13.5 for CD) and were shorter for bilateral repair in the LPC group (35.8 +/- 11.6 vs. 46.7 +/- 17.7).Two children in the CD group had injuries to their reproductive system during the operation (0.6%).The advantages of our technique include following: technically simple, short operation time, inspection of bilateral IIRs with simultaneous closure of cPPV, reproductive systems remain intact, routine addition of umbilicoplasty if desired, and essentially indiscernible wounds.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Saitama City Hospital, 2460, Mimuro, Midori-ku, Saitama-shi, 336-8522, Japan. emta@mxr.mesh.ne.jp

ABSTRACT

Background: Conventional open herniorrhaphy in children has been reported to have 0.3-3.8% recurrence and 5.6-30% postoperative contralateral hernia rates. We developed a unique technique to achieve completely extraperitoneal ligation of PPV without any skip areas under laparoscopic control. This report introduces our technique and results compared with the cut-down herniorrhaphy.

Methods: A consecutive series of 1,585 children with inguinal hernia/hydrocele (1996-2006) was analyzed. In laparoscopic patent processus vaginalis (PPV) closure (LPC), an orifice of PPV was encircled with a 2-0 suture extraperitoneally by a specially devised Endoneedle and tied up from outside of the body achieving completely extraperitoneal ligation of the ring. The round ligament was included in the ligation, whereas the spermatic cord and testicular vessels were excluded by advancing the needle across them behind the peritoneum. Cut-down herniorrhaphy (CD), with or without diagnostic laparoscopy, or LPC was selected according to parental preference under informed consent.

Results: Parents gave more preference to LPC (LPC in 1,257 children, CD in 308, and miscellaneous in 20). Age ranges were equal for both groups. Sex distribution showed female preponderance in the LPC group (44.8% vs. 26.6%, p < 0.001) and umbilical hernia/cysts were predominantly included in the LPC group (11.9% vs. 2.9%, p < 0.001). Mean operation times were equal for both groups for unilateral repair (28.2 +/- 9.2 for LPC vs. 27.8 +/- 13.5 for CD) and were shorter for bilateral repair in the LPC group (35.8 +/- 11.6 vs. 46.7 +/- 17.7). The incidence of postoperative hernia recurrence and contralateral hernia in the LPC group was 0.2% and 0.8%. Two children in the CD group had injuries to their reproductive system during the operation (0.6%).

Conclusions: The advantages of our technique include following: technically simple, short operation time, inspection of bilateral IIRs with simultaneous closure of cPPV, reproductive systems remain intact, routine addition of umbilicoplasty if desired, and essentially indiscernible wounds.

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Related in: MedlinePlus

Double ligation for infant younger than aged 1 year 6 months. An internal pursestring suture is placed, skipping over the spermatic cord and testicular vessels, proximally to the previously placed encircling suture
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Fig3: Double ligation for infant younger than aged 1 year 6 months. An internal pursestring suture is placed, skipping over the spermatic cord and testicular vessels, proximally to the previously placed encircling suture

Mentions: In laparoscopic PPV closure, a 2‚Äď0 suture, placed in the lower half of the internal inguinal ring through a 16-gauge sheath needle advanced extraperitoneally across the cord and vessels, was retrieved through the upper half of the ring by a specially devised needle (Fig.¬†1) and was tied up extracorporeally, achieving completely extraperitoneal ligation of the ring. Technical details are illustrated in Fig.¬†2. The procedure for girls was as described previously [7]. For infants younger than aged 1¬†year 6¬†months, the IIR was closed with double ligation (Fig.¬†3). If a cPPV was identified, it was closed.Fig.¬†1


Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy.

Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E - Surg Endosc (2009)

Double ligation for infant younger than aged 1 year 6 months. An internal pursestring suture is placed, skipping over the spermatic cord and testicular vessels, proximally to the previously placed encircling suture
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710496&req=5

Fig3: Double ligation for infant younger than aged 1 year 6 months. An internal pursestring suture is placed, skipping over the spermatic cord and testicular vessels, proximally to the previously placed encircling suture
Mentions: In laparoscopic PPV closure, a 2‚Äď0 suture, placed in the lower half of the internal inguinal ring through a 16-gauge sheath needle advanced extraperitoneally across the cord and vessels, was retrieved through the upper half of the ring by a specially devised needle (Fig.¬†1) and was tied up extracorporeally, achieving completely extraperitoneal ligation of the ring. Technical details are illustrated in Fig.¬†2. The procedure for girls was as described previously [7]. For infants younger than aged 1¬†year 6¬†months, the IIR was closed with double ligation (Fig.¬†3). If a cPPV was identified, it was closed.Fig.¬†1

Bottom Line: Mean operation times were equal for both groups for unilateral repair (28.2 +/- 9.2 for LPC vs. 27.8 +/- 13.5 for CD) and were shorter for bilateral repair in the LPC group (35.8 +/- 11.6 vs. 46.7 +/- 17.7).Two children in the CD group had injuries to their reproductive system during the operation (0.6%).The advantages of our technique include following: technically simple, short operation time, inspection of bilateral IIRs with simultaneous closure of cPPV, reproductive systems remain intact, routine addition of umbilicoplasty if desired, and essentially indiscernible wounds.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Saitama City Hospital, 2460, Mimuro, Midori-ku, Saitama-shi, 336-8522, Japan. emta@mxr.mesh.ne.jp

ABSTRACT

Background: Conventional open herniorrhaphy in children has been reported to have 0.3-3.8% recurrence and 5.6-30% postoperative contralateral hernia rates. We developed a unique technique to achieve completely extraperitoneal ligation of PPV without any skip areas under laparoscopic control. This report introduces our technique and results compared with the cut-down herniorrhaphy.

Methods: A consecutive series of 1,585 children with inguinal hernia/hydrocele (1996-2006) was analyzed. In laparoscopic patent processus vaginalis (PPV) closure (LPC), an orifice of PPV was encircled with a 2-0 suture extraperitoneally by a specially devised Endoneedle and tied up from outside of the body achieving completely extraperitoneal ligation of the ring. The round ligament was included in the ligation, whereas the spermatic cord and testicular vessels were excluded by advancing the needle across them behind the peritoneum. Cut-down herniorrhaphy (CD), with or without diagnostic laparoscopy, or LPC was selected according to parental preference under informed consent.

Results: Parents gave more preference to LPC (LPC in 1,257 children, CD in 308, and miscellaneous in 20). Age ranges were equal for both groups. Sex distribution showed female preponderance in the LPC group (44.8% vs. 26.6%, p < 0.001) and umbilical hernia/cysts were predominantly included in the LPC group (11.9% vs. 2.9%, p < 0.001). Mean operation times were equal for both groups for unilateral repair (28.2 +/- 9.2 for LPC vs. 27.8 +/- 13.5 for CD) and were shorter for bilateral repair in the LPC group (35.8 +/- 11.6 vs. 46.7 +/- 17.7). The incidence of postoperative hernia recurrence and contralateral hernia in the LPC group was 0.2% and 0.8%. Two children in the CD group had injuries to their reproductive system during the operation (0.6%).

Conclusions: The advantages of our technique include following: technically simple, short operation time, inspection of bilateral IIRs with simultaneous closure of cPPV, reproductive systems remain intact, routine addition of umbilicoplasty if desired, and essentially indiscernible wounds.

Show MeSH
Related in: MedlinePlus