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Technical refinements in single-port laparoscopic surgery of inguinal hernia in infants and children.

Chang YT - Diagn Ther Endosc (2010)

Bottom Line: This article comprehensively reviews and compares the various single-port techniques.These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect.Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung 80708, Taiwan.

ABSTRACT
The techniques of minimal access surgery for pediatric inguinal hernia are numerous and they continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port endoscopic-assisted percutaneous extraperitoneal closure seems to be the ultimate attainment, and numerous techniques have mushroomed in the past decade. This article comprehensively reviews and compares the various single-port techniques. These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect. However, most of these emerging techniques fail to entirely enclose the hernia defect and have the potential to lead to higher incidence of hernia recurrence. Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photo showing a 2-year-old boy receiving the hooked pin method. (a) Note right side inguinal hernia and the close proximity of the vas deferens (V) and testicular vessels (T) to the ring. (b) Introduction of the vascular catheter into the preperitoneal space along left side of the hernia defect. (c) The “preperitoneal hydrodissection” method. Injection of normal saline via the vascular catheter separates the vas and vessels from the peritoneum and allows the vascular catheter (arrow) to cross over. (d, e) The indwelling needle was removed, and a nonabsorbable suture was threaded through the sheath of the catheter, with the other end of the suture remaining above the skin. The sheath was then withdrawn. (f) The hook-pin device was easily made by modifying a pin used in orthopedic surgery. The device has a hook near the tip for catching hold of the suture. (g, h) Through the same stab incision, the hook-pin was introduced along the opposite side of the hernia defect into the intraabdominal space to pick up the silk, and the suture was then pulled through the abdominal wall. (i) The hernia defect was closed and the circuit suturing was tied extracorporeally.
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fig1: Intraoperative photo showing a 2-year-old boy receiving the hooked pin method. (a) Note right side inguinal hernia and the close proximity of the vas deferens (V) and testicular vessels (T) to the ring. (b) Introduction of the vascular catheter into the preperitoneal space along left side of the hernia defect. (c) The “preperitoneal hydrodissection” method. Injection of normal saline via the vascular catheter separates the vas and vessels from the peritoneum and allows the vascular catheter (arrow) to cross over. (d, e) The indwelling needle was removed, and a nonabsorbable suture was threaded through the sheath of the catheter, with the other end of the suture remaining above the skin. The sheath was then withdrawn. (f) The hook-pin device was easily made by modifying a pin used in orthopedic surgery. The device has a hook near the tip for catching hold of the suture. (g, h) Through the same stab incision, the hook-pin was introduced along the opposite side of the hernia defect into the intraabdominal space to pick up the silk, and the suture was then pulled through the abdominal wall. (i) The hernia defect was closed and the circuit suturing was tied extracorporeally.

Mentions: In 2008, the author developed a modified technique of SEAL and PIRS [10]. Under the laparoscopic guidance, the hernia defect was enclosed by a nonabsorbable suture, which was introduced into the abdomen by an 18 Fr vascular catheter (Surflash I.V. catheter, I.D. 0.95 × 64 mm, Terumo Corporation, Tokyo, Japan) on one side of the hernia defect and withdrawn on the opposite side by a hooked pin, which was made by an orthopedic pin (I.D. 1.8 mm, MES-CF01-063-21, Mizuho, Tokyo, Japan), through one needle puncture wound (Figure 1). During the procedure, 5 to 8 mL of isotonic saline solution were infused via the needle into the preperitoneal space to obtain the preperitoneal dissection of the hernia defect. The author started to perform the surgical technique in March 2007. From March 2007 to January 2010, a total of 288 procedures were performed among 201 consecutive infants and children. Of the technique, only one umbilical trocar wound and another stab incision were made (Figure 2). Besides, the hernia defect could be enclosed completely without a lower peritoneal gap since preperitoneal hydrodissection could safely separate the peritoneum from the vas and the vessels. Since the used vascular catheter and hooked pin were long enough (64 mm and 300 mm, resp.), failure to lift up the peritoneum entirely was rare. However, some upper subcutaneous tissues, including nerves and muscles, may cause injury by their inclusion in the upper portion of the circuit suturing. The inclusion of unnecessary subcutaneous tissues in the ligature may lead to a propensity for subsequent loosening of the knot, causing later recurrence [2].


Technical refinements in single-port laparoscopic surgery of inguinal hernia in infants and children.

Chang YT - Diagn Ther Endosc (2010)

Intraoperative photo showing a 2-year-old boy receiving the hooked pin method. (a) Note right side inguinal hernia and the close proximity of the vas deferens (V) and testicular vessels (T) to the ring. (b) Introduction of the vascular catheter into the preperitoneal space along left side of the hernia defect. (c) The “preperitoneal hydrodissection” method. Injection of normal saline via the vascular catheter separates the vas and vessels from the peritoneum and allows the vascular catheter (arrow) to cross over. (d, e) The indwelling needle was removed, and a nonabsorbable suture was threaded through the sheath of the catheter, with the other end of the suture remaining above the skin. The sheath was then withdrawn. (f) The hook-pin device was easily made by modifying a pin used in orthopedic surgery. The device has a hook near the tip for catching hold of the suture. (g, h) Through the same stab incision, the hook-pin was introduced along the opposite side of the hernia defect into the intraabdominal space to pick up the silk, and the suture was then pulled through the abdominal wall. (i) The hernia defect was closed and the circuit suturing was tied extracorporeally.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2874921&req=5

fig1: Intraoperative photo showing a 2-year-old boy receiving the hooked pin method. (a) Note right side inguinal hernia and the close proximity of the vas deferens (V) and testicular vessels (T) to the ring. (b) Introduction of the vascular catheter into the preperitoneal space along left side of the hernia defect. (c) The “preperitoneal hydrodissection” method. Injection of normal saline via the vascular catheter separates the vas and vessels from the peritoneum and allows the vascular catheter (arrow) to cross over. (d, e) The indwelling needle was removed, and a nonabsorbable suture was threaded through the sheath of the catheter, with the other end of the suture remaining above the skin. The sheath was then withdrawn. (f) The hook-pin device was easily made by modifying a pin used in orthopedic surgery. The device has a hook near the tip for catching hold of the suture. (g, h) Through the same stab incision, the hook-pin was introduced along the opposite side of the hernia defect into the intraabdominal space to pick up the silk, and the suture was then pulled through the abdominal wall. (i) The hernia defect was closed and the circuit suturing was tied extracorporeally.
Mentions: In 2008, the author developed a modified technique of SEAL and PIRS [10]. Under the laparoscopic guidance, the hernia defect was enclosed by a nonabsorbable suture, which was introduced into the abdomen by an 18 Fr vascular catheter (Surflash I.V. catheter, I.D. 0.95 × 64 mm, Terumo Corporation, Tokyo, Japan) on one side of the hernia defect and withdrawn on the opposite side by a hooked pin, which was made by an orthopedic pin (I.D. 1.8 mm, MES-CF01-063-21, Mizuho, Tokyo, Japan), through one needle puncture wound (Figure 1). During the procedure, 5 to 8 mL of isotonic saline solution were infused via the needle into the preperitoneal space to obtain the preperitoneal dissection of the hernia defect. The author started to perform the surgical technique in March 2007. From March 2007 to January 2010, a total of 288 procedures were performed among 201 consecutive infants and children. Of the technique, only one umbilical trocar wound and another stab incision were made (Figure 2). Besides, the hernia defect could be enclosed completely without a lower peritoneal gap since preperitoneal hydrodissection could safely separate the peritoneum from the vas and the vessels. Since the used vascular catheter and hooked pin were long enough (64 mm and 300 mm, resp.), failure to lift up the peritoneum entirely was rare. However, some upper subcutaneous tissues, including nerves and muscles, may cause injury by their inclusion in the upper portion of the circuit suturing. The inclusion of unnecessary subcutaneous tissues in the ligature may lead to a propensity for subsequent loosening of the knot, causing later recurrence [2].

Bottom Line: This article comprehensively reviews and compares the various single-port techniques.These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect.Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung 80708, Taiwan.

ABSTRACT
The techniques of minimal access surgery for pediatric inguinal hernia are numerous and they continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port endoscopic-assisted percutaneous extraperitoneal closure seems to be the ultimate attainment, and numerous techniques have mushroomed in the past decade. This article comprehensively reviews and compares the various single-port techniques. These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect. However, most of these emerging techniques fail to entirely enclose the hernia defect and have the potential to lead to higher incidence of hernia recurrence. Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.

No MeSH data available.


Related in: MedlinePlus