PurposeTo evaluate the safety, efficacy and merits of laparoscopic repair in children with hydroceles by comparing the outcomes of laparoscopic repair and the traditional open repair (OR) procedure. The outcomes of the following three laparoscopic percutaneous extra-peritoneal closure (LPEC) approaches were also compared: conventional two-port surgery, transumbilical single-site two-port surgery and single-port surgery.MethodsWe retrospectively compared the demographic, perioperative and follow-up data from the consecutive records obtained for 382 boys who underwent OR and 950 boys who underwent LPEC at two children’s medical centres in China. In the LPEC group, regardless of the hydrocele form, one of the three approaches with percutaneous aspiration was performed: conventional two-port surgery was performed in 387 cases, single-site two-port surgery was performed in 468 cases and single-port surgery was performed in 95 cases. The clinical data and complications were statistically analysed.ResultsPostoperative follow-up data were obtained for all the patients. The mean follow-up time was 36 months (24–48 months) in the OR group and 32.5 months (20–44 months) in the LPEC group. Significant differences in recurrence were not observed between the groups (five in the OR and 10 in the LPEC; P = 0.69). However, the operation time, postoperative hospital stay, incidence of scrotal oedema, incision infection and contralateral metachronous hernia or hydrocele were significantly higher in the OR group than those in the LPEC group (P < 0.01). Eighteen children (4.71%) had a negative exploration of the patent processus vaginalis (PPV) in the OR group. Fourteen children (1.47%) in the LPEC group had a closed internal ring and were converted to a scrotal procedure. Significant differences in the clinical data or complications were not observed between the two centres for the laparoscopic procedure (P > 0.05). Contralateral PPV (cPPV) was found in 18 patients in the single-port group (18.9%). Of the patients affected with cPPV, significant differences were observed between the single-port group and the two-port LPEC group (122 patients, 31.5%, P = 0.016) and the single-site two-port group (the 148 patients, 31.6%, P = 0.013). A contralateral metachronous hernia or hydrocele was found in zero, zero and two cases in these groups, respectively, and significant differences were observed (P < 0.01) between the single-site surgery and the other two laparoscopic approaches.ConclusionsLPEC is safe, feasible and effective for treating hydroceles in children and has the same recurrence rate as OR. However, LPEC is superior in operation time, hospital stay, occurrence of scrotal oedema, incision infection and occurrence of metachronous hernia or hydrocele. The transumbilical single-site two-port procedure has the same cosmetic effect as the single-port LPEC. According to our experience, the two-port LPEC approach is better for diagnosing cPPV and reducing metachronous hernia or hydrocele than the single-port LPEC procedure.

Background: For the treatment of long bone defects of the extremities caused by trauma, infection, tumors, and nonunion, it has been a challenge for clinical orthopedic surgeons. Bone transport technique have become the only way to treat bone defects. However, inevitable docking site complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate risk factor of docking site complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity. Aim: The purpose of this study was to investigate the risk factors associated with docking site complication treated with Ilizarov bone transport technique in the treatment of tibial bone defect. Methods: The retrospective study including 103 patients who underwent bone transport for the treatment of large bone defect in tibia from October 2012 to October 2019. There were 90 male and 13 females with a mean age of 37 years (range 17-66years). The etiology of bone defect includes high-energy trauma in 25 cases, osteomyelitis in 61 and nonunion in 17. There were 19 cases in the proximal 1/3 of the diaphysis, middle 1/3 in 39 and distal 1/3 in 45 cases. There were 12 limbs in active infected state with sinus and drainage.17 patients suffered soft tissue defect after debridement. The mean bone defect was 6.6cm (range 3-13cm). Single bone transport in 80 cases, and double in 23 cases. The docking time, external fixation time, external fixation index, and docking site complications were documented and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the docking site complication of tibial bone defect treated with Ilizarov bone transport technique. The clinical outcomes were evaluated using Association for the Study and Application of the method of Ilizarov criteria (ASAMI) at last clinical visit. Results: 103 patients were followed up for (24-48) months, with an average of 27.5 months, The soft tissue were successfully managed by musculocutaneous flap transfer in 17 cases. However, multiple complications occurred in docking site, with an average of 0.53 complications per patient, an average of 0.16 minor complications and 0.38 major complications per patient. Delayed union in 22 cases (21.4%), axial deviation in 19 cases (18.4%) and soft tissue incarceration in 10 cases (9.7%). According to the results of logistic regression analysis, the distance of bone defect (P=0.001,OR=1.976), and distal 1/3 (P=0.01,OR =1.976) were are risk factors for delayed union. Bone defect distance (P< 0.001, OR = 1.981), external fixation time (P = 0.012, OR= 1.017) were risk factors for axial deviation. Soft tissue defect (P=0.047,OR =6.766) and the number previous operation (P=0.001, OR =2.920) were risk factors for soft tissue incarceration. Base on ASAMI bone score, bony result was excellent in 91 patients, good in 7, fair in 3 and poor in 2. The ASAMI functional result was excellent in 67 patients, good in 26, fair in 8, poor in 2. Conclusion: Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect distance, external fixation time, the number of previous operations, soft tissue defects and the distal 1/3 are risk factors for complications at the docking site, and clinicians should pay attention to them.