Laparoscopic treatment of congenital inguinal hernia in children

ABSTRACT ABSTRACT ABSTRACTNeedlescopic techniques have been used recently in repairing inguinal hernias (IH), which has made this type of surgery more feasible and less invasive. The technique is being developed further. The objective of this study is to describe and assess the results that can be achieved by using a new simplified techinque (Reverdin needle, RN) in needlescopic inguinal herniorrhaphy (NH) in children. All patients with symptomatic IH confirmed by clinical examination were subjected to elective needlescopic herniorrhaphy. One-hundred and fifty patients with 186 groin hernias, from two hospitals in Egypt and Saudi Arabia, in the period from October 1999 to May 2002, were assinged to NH using RN. The RN was used to insert a purse-string suture around the internal inguinal ring (IIR) to be tied extracorporeally. A total of 186 IH defects in 150 children were repaired successfully. There were 130 males and 20 females with a mean age of 20.58+21 months (range 8-96 months). Right-sided IH was present in 86 patients (57.33%); among these patients, an opened IIR was found and repaired in 12 cases (8%). Left-sided IH was present in 30 cases (20%), bilateral hernia in 19 cases (12.67%), and recurrent IH in 20 cases (10%). The mean duration of surgery was 8.7+1.18 min for unilateral and 12.35+2 min for bilateral hernia repair. No intra or postoperative complications. The mean hospital stay was 7.79+1.28 h. The new technique had all the advantages of needlescopic herniorrhaphy in children (less invasive, less pain, short hospital stay) combined with the advantages of reduced operating time, simplicity, and feasibility. It may be preferable for the intracorporeal suturing and knot tying. However, it needs longterm follow up.

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“…[2], [8], [13], [14] In the present study, no single case of recurrence was seen at 1-year follow-up and the scars were almost invisible.…”

Section: Discussionmentioning

confidence: 60%

“…[6], [8] Our technique requires only one 3-mm operating port and RN to close the IIR and there was no need to incise the peritoneum at the internal ring. As shown from the results of this study, NH using RN has a high-success rate, and no injury to the spermatic cord structures and no recurrences were reported.…”

Section: Discussionmentioning

confidence: 99%

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Shalaby

Fawy

Soliman

et al. 2005

J Indian Assoc Pediatr Surg

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“…As principais aplicações nas quais a laparoscopia é considerada verdadeiro avanço terapêutico por nós e outros cirurgiões são a DRGE com ou sem hérnia hiatal 8,9 , a criptorquia alta 10,11 , o abdome agudo com dúvida diagnós-tica, sobretudo em meninas adolescentes 1,12,13 , o trauma abdominal fechado ou aberto (faca ou arma de fogo) 14 , a obstrução por bridas 15,16 , o megacólon congênito (dispensando a colostomia) 6,17 , as doenças do ovário 18,19 , a colecistectomia 20 , a esplenectomia 6,21 , o diagnóstico por bióp-sias 1,6,22 , o estadiamento de doença de Hodgkin ou outros tumores 23,24 , as hérnias diafragmáticas, o volvo gástrico 25 , os cistos ou divertículos, a investigação de icterícia e hérnia inguinal contralateral 1,26,27 . Além das indicações cirúrgi-cas citadas na Tabela 1, há muitas outras já publicadas que ainda não utilizamos.…”

Section: Discussionunclassified

“…Ainda é bastante controversa a indicação da videolaparoscopia para tratamento da estenose hipertrófica do piloro 6,38 , hérnias inguinais na criança 26,27 , fase inicial de apendicite em crianças pequenas ou magras 1,12,13 , biópsia renal e varicocele 32 . Em todos estes casos, as operações por via aberta por mini-incisões estéticas são fáceis e de baixa morbidade.…”

Section: Discussionunclassified

Applications of videolaparoscopic surgery in children

Esteves

Neto

et al. 2001

J Pediatr (Rio J)

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ResumenObjetivo: apresentar a casuística de videolaparoscopias do serviço, analisando as principais indicações para operações videolaparoscópicas em pediatria e considerando as vantagens e desvantagens em relação aos procedimentos convencionais por laparotomia.Métodos: análise retrospectiva de 612 videolaparoscopias em crianças com idades de 8 dias a 17 anos, operadas de novembro/1995 a 2000. São descritos os princípios básicos da videolaparoscopia e o manejo pós-operatório nas inúmeras indicações pediátricas. Os resultados, vantagens e complicações foram analisados após um período de seguimento de até 5 anos.Resultados: a cirurgia laparoscópica permitiu realizar vários procedimentos abdominais convencionalmente efetuados por via aberta, sobretudo no tratamento do refluxo gastroesofágico, abdome agudo inflamatório, criptorquidia, obstrução por bridas, litíase biliar, tumores, afecções de ovário, esplenectomia, aganglionose, trauma e outros. A morbidade foi baixa (1%) e a mortalidade devido à laparoscopia foi nula. Houve conversão para laparotomia em somente 14 casos (2,3%), sobretudo em trauma. As principais vantagens incluíram mínimos trauma cirúrgico, dor e íleo paralítico, pouco tempo de internação, quase ausência de hérnia incisional e melhor estética.Conclusões: a videolaparoscopia parece ser um grande avanço da cirurgia pediátrica moderna, permitindo tratar de modo menos invasivo e com segurança grande parte das afecções abdominais em crianças de todas as idades.J Pediatr (Rio J) 2001; 77 (5): 407-12: cirurgia pediátrica, videolaparoscopia, refluxo gastroesofágico, abdome agudo, trauma. AbstractObjectives: to present the videolaparoscopies performed by the Children's Surgery Service, and study the main indications for pediatric laparoscopic surgeries, considering advantages and disadvantages over conventional open procedures.Methods: retrospective analysis of 612 videolaparoscopies in children aged between 8 days and 17 years treated from November/ 95 to 2000. Basic principles of videolaparoscopy and the postoperative management of several pediatric diseases are described. The results, advantages, and complications were analyzed after a 5-year follow-up period.Results: laparoscopic surgery allowed for a wide series of abdominal procedures conventionally carried out through open surgery, mainly for the treatment of gastroesophageal reflux disease, inflammatory acute abdomen, adhesive intestinal obstruction, biliary lithiasis, tumors, cryptorchidism, ovarian diseases, splenectomies, aganglionosis, trauma and others. Morbidity was low (1%), and mortality due to laparoscopy was nonexistent. Conversion to laparotomy occurred in only 14 cases (2.3%), mainly because of trauma. The principal advantages included minimal surgical trauma, pain and reflex ileum, short hospital stay, almost no incisional hernias and better cosmetic scars.Conclusions: videolaparoscopy seems to be a great advance in modern pediatric surgery, allowing safer and less invasive treatment of a wide series of abdominal diseases at all pediatri...

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“…As the techniques evolve, new strategies have been applied, as the use of natural orifices, robotically assisted procedures and percutaneous laparoscopic assisted procedures, in a quest to be even less invasive. While the open techniques for indirect inguinal hernia correction, a common procedure in pediatric surgery, are well established and have had their own evolution, laparoscopic correction has emerged in this global context [1,2], peaking nowadays for some into a scar less percutaneous procedure [3].…”

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confidence: 99%

Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study

Reino-Pires

Pêgo

Miranda

et al. 2017

Journal of Pediatric Surgery

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Purpose: We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population. Methods: Twenty-eight rabbits were divided in 2 groups: group I (female morphology) -persistence of the peritoneal-vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) -persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2-0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation. Results: Ultrasound allowed characterization of inguinal-crural structures. Group I -complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II -complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged. Conclusions: Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair.© 2017 Elsevier Inc. All rights reserved.Since the dawn of laparoscopy, minimally invasive surgery has been spreading worldwide. As the techniques evolve, new strategies have been applied, as the use of natural orifices, robotically assisted procedures and percutaneous laparoscopic assisted procedures, in a quest to be even less invasive. While the open techniques for indirect inguinal hernia correction, a common procedure in pediatric surgery, are well established and have had their own evolution, laparoscopic correction has emerged in this global context [1,2], peaking nowadays for some into a scar less percutaneous procedure [3].Simultaneously, the ultrasound technology has evolved greatly, with the technology becoming more available and being currently used in areas other than radiology and diagnostics. The ultrasound-guided loco-regional anesthesia is a well-established example of the ultrasound utility in a surgical setting [4,5]. Likewise, ultrasound imaging is for some the diagnostic exam for a groin hernia [6,7] as well as a resource that can be accurately used by a surgeon as a diagnostic tool [8,9].Aiming for an even less invasive procedure, based in the laparoscopic assisted procedure experience, we postulate that an ultrasoundguided internal ring suture (UGIRS) could be a reproducible, feasible, reliable and safe procedure for indirect inguinal hernia in pediatric female patients, avoiding the inherent risks of an abdominal cavity entry and pneumoperitoneum. Therefore we conducted this study in an animal model aiming to prove this concept. To accomplish this, we performed an UGIRS in a living rabbit model using a 20G peripheral IV catheter and a 2/0 monofilament non-absorbable suture, dividing th...

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Laparoscopic treatment of congenital inguinal hernia in children

Cited by 194 publications

References 19 publications

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Applications of videolaparoscopic surgery in children

Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study

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