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Sadecka AI, Wolski M. Major Complication Caused by Inguinal Hernia Recurrence After Percutaneous Internal Ring Suturing Procedure in a Patient With Loeys-Dietz Syndrome: A Case Report. Cureus 2024; 16:e61449. [PMID: 38947654 PMCID: PMC11214812 DOI: 10.7759/cureus.61449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Inguinal hernia repair is one of the most frequently performed procedures in pediatric surgery. Treatment methods include classical open repair and laparoscopic approach. In this report we analyze a case of a 14-month-old boy with Loeys-Dietz syndrome treated for an inguinal hernia with laparoscopic percutaneous internal ring suturing (PIRS). Two weeks post-operatively the patient was diagnosed with a recurrence of the hernia complicated by an intestine strangulation. As a re-operation of the hernia, the Lichtenstein method was applied successfully. We analyzed the literature to determine the safety and possible contradictions of the PIRS procedure, with particular emphasis on patients with comorbidities such as connective tissue disorders. We conclude that in the PIRS procedure, despite its safety, feasibility and low complication rate in healthy patients, too few studies were made to draw similar conclusions for patients with comorbidities such as connective tissue disorders.
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Affiliation(s)
| | - Marek Wolski
- Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, POL
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Cheng PL, Duh YC, Chen JJ, Huang FH. Laparoscopic Extraperitoneal Hernia Repair Versus Open Repair in Boys with Inguinal Hernia: A Meta-analysis. J Pediatr Surg 2023:S0022-3468(23)00090-8. [PMID: 36898876 DOI: 10.1016/j.jpedsurg.2023.01.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Pediatric inguinal hernia is a common surgical problem in boys. Open hernia repair surgery (OH) has been traditionally used to treat this condition, but it leads to complications, such as testicular complications. Laparoscopic hernia repair by using the extraperitoneal method (LHE) is performed through the percutaneous insertion of sutures and extracorporeal closure of patent vaginalis processus; thus, injury to spermatic cord structures is avoided. However, a meta-analysis comparing LHE and OH is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. A meta-analysis of the retrieved studies was performed, and a random-effects model was used to calculate the pooled effect size. The primary outcome was testicular complications, including ascending testis, hydrocele, and testicular atrophy. The secondary outcomes were surgical metachronous contralateral inguinal hernia (MCIH), ipsilateral hernia recurrence, and operation time. RESULTS In total, 6 randomized controlled trials (RCTs) and 20 non-RCTs involving 17,555 boys were included. The incidence of ascending testis (risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.18-0.78; p = 0.008) and MCIH (RR: 0.17, 95% CI: 0.07-0.43; p = 0.0002) was significantly lower in LHE than in OH. The incidence of hydrocele, testicular atrophy, and ipsilateral hernia recurrence did not differ between LHE and OH. CONCLUSION Compared with OH, LHE led to fewer or equivalent testicular complications without increasing ipsilateral hernia recurrence. Moreover, MCIH incidence was lower in LHE than in OH. Hence, LHE could be a feasible choice with less invasiveness for inguinal hernia repair in boys. LEVEL OF EVIDENCE Treatment study, LEVEL III.
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Affiliation(s)
- Po-Lung Cheng
- Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yih-Cherng Duh
- Division of Pediatric Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jeng-Jung Chen
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu City, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
| | - Fu-Huan Huang
- Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan.
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Wolak PK, Strzelecka A, Piotrowska - Gall A, Wolak PP, Piotrowska I, Dąbrowska K, Wróbel J, Nowak-Starz G. Percutaneous Internal Ring Suturing (PIRS) – The Benefits of Laparoscopic Inguinal Hernia Repair. Ther Clin Risk Manag 2022; 18:135-144. [PMID: 35237037 PMCID: PMC8882976 DOI: 10.2147/tcrm.s348197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery. Purpose The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques. Patients and Methods We conducted a retrospective study that included children aged 0–18 treated using the PIRS technique in 2008–2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method. Results The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia. Conclusion The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.
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Affiliation(s)
- Przemysław Karol Wolak
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
- Correspondence: Przemysław Karol Wolak, Tel +48 501 525 549, Email
| | | | - Aneta Piotrowska - Gall
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
| | | | | | - Katarzyna Dąbrowska
- Department of Neonatology and Neonatal Intensive Care, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Joanna Wróbel
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020321. [PMID: 35054015 PMCID: PMC8781267 DOI: 10.3390/jcm11020321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. SUMMARY BACKGROUND DATA Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. RESULTS Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: -11.90 min, 95% CI: -16.63 to -7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. CONCLUSIONS LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.
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Wolak PK, Strzelecka A, Piotrowska A, Dąbrowska K, Wolak PP, Piotrowska I, Nowak-Starz G. The Operative Time for Unilateral Inguinal Hernia Repair in Children Performed with Percutaneous Internal Ring Suturing (PIRS) or Open Approach Method. J Clin Med 2021; 10:jcm10061293. [PMID: 33800993 PMCID: PMC8004003 DOI: 10.3390/jcm10061293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, we compared the operative time for unilateral inguinal hernia repair in children performed with either an open approach (OA) or the Percutaneous Internal Ring Suturing (PIRS) method. It was a retrospective chart review of all patients ages 0 to 18 who underwent unilateral inguinal hernia repair in the Department of Pediatric Surgery, Urology and Traumatology of the Regional Hospital in Kielce between January 2011 and December 2018. Patients with bilateral hernias or additional problems were excluded. Of 878 patients qualified for the study, 701 were in the OA group and 177 in the PIRS group. Overall, the time needed to complete the procedure was significantly longer for the OA method. The operative time was longer if the hernia was left-sided (p = 0.024). Analysis by gender showed that operative time was generally longer in males. For both genders, surgery was shorter if the PIRS method was used. For males in the PIRS group the operative time was affected by the location of the hernia, and it was longer for a left-sided hernia. The take-home message is that the PIRS procedure is faster than the OA for inguinal hernia repair in children and it might be considered as a preferred method, especially in females.
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Affiliation(s)
- Przemyslaw Karol Wolak
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
- Department of Pediatric Surgery, Urology and Traumatology Provincial Hospital, ul. Grunwaldzka 45, 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-501-525-549
| | - Agnieszka Strzelecka
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Aneta Piotrowska
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Katarzyna Dąbrowska
- Department of Neonatology and Neonatal Intensive Care, Polish Mothers Health Research Institute, ul. Rzgowska 281/289, 93-338 Łódź, Poland;
| | | | - Ilona Piotrowska
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Grażyna Nowak-Starz
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
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A Comprehensive Review and Update of Post-surgical Cutaneous Nerve Entrapment. Curr Pain Headache Rep 2021; 25:11. [PMID: 33547511 DOI: 10.1007/s11916-020-00924-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the literature regarding post-surgical cutaneous nerve entrapment, epidemiology, pathophysiology, and clinical presentation. It focuses mainly on nerve entrapment leading to chronic pain and the available therapies. RECENT FINDINGS Cutaneous nerve entrapment is not an uncommon result (up to 30% of patients) of surgery and could lead to significant, difficult to treat chronic pain. Untreated, entrapment can lead to neuropathy and damage to enervated structures and musculature, and significant morbidity and financial loss. Nerve entrapment is defined as pressure neuropathy from chronic compression. It causes changes to all layers of the nerve tissue. It is most significantly associated with hernia repair and other procedures employing a Pfannenstiel incision. The initial insult is usually incising of the nerve, followed by formation of a neuroma, incorporation of the nerve during closing, or constriction from adhesions. The three most commonly involved nerves are the iliohypogastric, ilioinguinal, and genitofemoral nerves. Cutaneous abdominal nerve entrapment could occur during thoracoabdominal surgery. The presentation of nerve entrapment usually involved post-surgical pain in the territory innervated by the trapped nerve, possibly with radiation that tracks the nerve course. Once a suspected neuropathy is identified, it can be diagnosed with relief in pain after a nerve block has been instilled. Treatment is usually started with pharmaceutical solutions, topical first and oral if those fail. Most patients require escalation to a second line of treatment and see good result with injection therapy. Those that require further escalation can choose between ablation and surgical therapies. Post-surgical nerve entrapment is not uncommon and causes serious morbidity and financial loss. It is underdiagnosed and thus undertreated. Preventing nerve entrapment is the best treatment; when it does occur, options include topical and oral analgesics, nerve blocks, ablation therapy, and repeat surgery.
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Oral A, Karaca L, Ahiskalioglu A, Yildiz A, Yigiter M, Celikkaya ME, Chyndolotov T, Salman AB. Effects of Laparoscopic Hernia Repair by PIRS (Percutan Internal Ring Suturing) Technique on Testicular Artery Blood Supply. J INVEST SURG 2018; 32:343-347. [PMID: 29393725 DOI: 10.1080/08941939.2017.1419317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: Percutaneous internal ring suturing technique (PIRS) is a minimally invasive technique in pediatric inguinal hernia repair. In the present study, a negative effect on testicular blood flow using PIRS technique has been investigated. Methods: Forty male patients were included in the study prospectively. Two groups were formed as conventional open surgery (Group I) and PIRS technique (Group II). The resistive index (RI) value of the testicular artery was measured prospectively by using SMI (superb micro-vascular imaging) software with the color doppler ultrasound technique preoperatively and postoperatively at the first month. Results: Inguinal hernia was present on the left in 35% (n = 14) of the patients and on the right in 65% (n = 26) of the patients. There was no statistically significant difference (p = 0.727) between Group I and II with regard to preoperative RI value (0.66 ± 0.07 vs. 0.66 ± 0.45, respectively). Similarly, there was no statistically significant difference (p = 0.220) between Group I and II with regard to the RI values measured at the postoperative first month (0.58 ± 0.04 vs. 0.60 ± 0.04, respectively). Although the postoperative RI values decreased compared to the preoperative values in both groups, this difference was not statistically significant. (p = 0.447 in Group I, and p = 0.175 in Group II for intragroup comparison). Conclusions: Besides PIRS technique has the advantages provided by all other laparoscopic techniques defined for inguinal hernia repair, there is no significant difference between this technique and conventional open surgery with regard to testicular blood flow. It is an innovative candidate technique instead of the open surgery method besides its additional advantages.
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Affiliation(s)
- Akgun Oral
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey.,e Department of Pediatric Surgery , Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Leyla Karaca
- b Department of Radiology , Ataturk University School of Medicine , Erzurum , Turkey
| | - Ali Ahiskalioglu
- c Department of Anesthesiology and Reanimation , Ataturk University School of Medicine , Erzurum , Turkey
| | - Abdullah Yildiz
- d Department of Pediatric Surgery , Sisli Etfal Training and Research Hospital , İstanbul , Turkey
| | - Murat Yigiter
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Mehmet Emin Celikkaya
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Temirlan Chyndolotov
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Ahmet Bedii Salman
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
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Thomas DT, Göcmen KB, Tulgar S, Boga I. Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases. J Pediatr Surg 2016; 51:1330-5. [PMID: 26777889 DOI: 10.1016/j.jpedsurg.2015.11.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/04/2015] [Accepted: 11/29/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Percutaneous internal ring suturing (PIRS) is a minimally invasive method for repair of pediatric inguinal hernia. In this study we report our experience with PIRS. METHODS All children >10kg presenting to our institute between June 2013 and March 2015 with a diagnosis of indirect inguinal hernia or communicating hydrocele underwent laparoscopic repair using PIRS technique. Patients' gender, age at surgery, side of inguinal hernia/communicating hydrocele at diagnosis, peroperative findings, surgical and anesthesia times plus follow-up findings were collected. RESULTS Two-hundred thirteen patients underwent 250 procedures. Inguinal hernia or communicating hydrocele was diagnosed on the right side in 113 (53.1%), the left side in 75 (35.2%) and bilaterally in 25 patients (11.7%). Contralateral hernia was found in 35 patients (16.4%). Mean surgery time was 14.3min for unilateral and 20.4min for bilateral PIRS, and mean anesthesia time was 33.6min for unilateral and 39.1min for bilateral PIRS. Average follow-up time was 9.6months. Recurrence was seen in 3 (1.4%) and complications in 6 patients (2.8%). CONCLUSION PIRS is a simple, safe and effective method for the treatment of inguinal hernia and communicating hydrocele in children.
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Affiliation(s)
| | - Kamil Basar Göcmen
- Pendik State Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Serkan Tulgar
- Pendik State Hospital, Department of Anesthesiology & Reanimation, Istanbul, Turkey
| | - Ibrahim Boga
- Pendik State Hospital, Department of Anesthesiology & Reanimation, Istanbul, Turkey
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