Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience.

Abstract

IntroductionPercutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus.AimTo evaluate the usefulness of the PIRS technique.Material and methodsFifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010.ResultsIn 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery.ConclusionsInguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery).

Хірургічна Корекція Пахвинних Гриж В Дітей Із Застосуванням Міні-Інвазивного Методу PIRS

“…У 2006 році D. Patkowski за-пропонував власну методику лапароскопічної корекції пахвинних гриж у дітей. Переваги цього методу -це застосування лише одного оптично-го порту діаметром 3-5 мм та відсутність потреби в накладанні інтракорпоральних швів, що є най-більш складним елементом малоінвазивної хірур-гії, особливо для початківців [12,13].…”

“…Він включає в себе черезшкірне ушивання внутрішнього кільця пахвинного каналу під відеоконтролем через ла-пароскопічний телескоп, що введений у черевну порожнину в ділянці пупка [12,13].…”

Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair

“…However, because this is a technique of percutaneous closure of inguinal hernias, the inclusion of tissues between the skin and hernia sac, including nerves and muscles, may cause injury and increase the postoperative morbidity in the long[6][7][8][9][10][11][12][13]. In addition to the suture may cut through the muscles with subsequent loosening of the suture around IIR causing recurrence of the hernia.…”

“…In addition, entangling of muscular tissues with the suture may result in increased rate of recurrence due to loosening of the suture and cut through the muscular tissues. [6,7] In laparoscopic surgery, intracorporeal knot tying involves the use of two instruments with comfortable angels while in SIPES it is not usually possible to utilize two instruments for knot tying as they lie almost parallel without triangulation making the suturing and knot tying very challenging tasks [1,8]. That has stimulated us to introduce a hybrid of techniques and innovated others to develop a simple easy and secure way for single incision laparoscopic hernia repair Ninety-five percent of patients were available for follow-up at a mean of 2.±24.2 years (range=10 month -3 years) and all showed an excellent cosmetic result with nearly invisible scar.…”

Percutaneous endoscopic gastrostomy – a simple solution to a complex problem

“…The PEG may be inserted even in infants with body weight of over 3-3.5 kg [5]. Recent reports and a change in the method of placing the PEG proposed by Seifarth, described as an endoscopic gastrostomy button with a double-lasso [6], patterned on the laparoscopic technique for inguinal hernia repair by Patkowski et al [7,8], allows the placement of the PEG in children with weight below 3 kg [6]. It is the method of enteral feeding applied in the group of patients whose clinical status makes oral food supply impossible or considerably limited.…”