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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

A 2-year-old girl receiving the hooked pin method. (a) Note left side inguinal hernia before operation. (b) The hernia defect was closed after operation. (c) Laparoscopic surgery for other reasons was performed 94 days after operation. Note the peritoneal scarring occurred in closure of the hernia defect.
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fig4: A 2-year-old girl receiving the hooked pin method. (a) Note left side inguinal hernia before operation. (b) The hernia defect was closed after operation. (c) Laparoscopic surgery for other reasons was performed 94 days after operation. Note the peritoneal scarring occurred in closure of the hernia defect.

Mentions: Postsurgical peritoneal adhesions are a consequence of injured peritoneal surface (including incision, cauterization, suturing, or other means of trauma) fusing together to form scar tissue [14]. Of the inguinal hernia sac, the endothelium is the continuity of peritoneal mesothelium. In the open herniotomy, trauma due to traverse of the suture and tissue reaction of the suture material may also cause peritoneal adhesion and fibrosis (Figure 3). Since the tensile strength of any suture may diminish eventually, the author suggests that peritoneal adhesion and fibrosis may be the leading factor for complete obliteration of the hernia defect in the long run after either open herniotomy or laparoscopic surgery (Figure 4). Thus, how can adequate peritoneal adhesions during hernia operation in the era of minimal access surgery are applied? Since partial omission of the defect circumference was the reported factor contributing to recurrence in laparoscopic surgery [2], completely enclosing the hernia defect without gaps, the same as suture ligation in the open herniotomy, is crucial to moving towards a near-zero recurrence rate.


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

Chang YT - Diagn Ther Endosc (2010)

A 2-year-old girl receiving the hooked pin method. (a) Note left side inguinal hernia before operation. (b) The hernia defect was closed after operation. (c) Laparoscopic surgery for other reasons was performed 94 days after operation. Note the peritoneal scarring occurred in closure of the hernia defect.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2874921&req=5

fig4: A 2-year-old girl receiving the hooked pin method. (a) Note left side inguinal hernia before operation. (b) The hernia defect was closed after operation. (c) Laparoscopic surgery for other reasons was performed 94 days after operation. Note the peritoneal scarring occurred in closure of the hernia defect.
Mentions: Postsurgical peritoneal adhesions are a consequence of injured peritoneal surface (including incision, cauterization, suturing, or other means of trauma) fusing together to form scar tissue [14]. Of the inguinal hernia sac, the endothelium is the continuity of peritoneal mesothelium. In the open herniotomy, trauma due to traverse of the suture and tissue reaction of the suture material may also cause peritoneal adhesion and fibrosis (Figure 3). Since the tensile strength of any suture may diminish eventually, the author suggests that peritoneal adhesion and fibrosis may be the leading factor for complete obliteration of the hernia defect in the long run after either open herniotomy or laparoscopic surgery (Figure 4). Thus, how can adequate peritoneal adhesions during hernia operation in the era of minimal access surgery are applied? Since partial omission of the defect circumference was the reported factor contributing to recurrence in laparoscopic surgery [2], completely enclosing the hernia defect without gaps, the same as suture ligation in the open herniotomy, is crucial to moving towards a near-zero recurrence rate.

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