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Eurlings R, Killaars REM, Visschers RGJ, van Gemert WG. Testicular Vascularization after Pediatric Inguinal Hernia Repair: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:409. [PMID: 38671625 PMCID: PMC11049011 DOI: 10.3390/children11040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The effect of pediatric inguinal hernia repair (IHR) on testicular vascularization remains unclear. Manipulating the spermatic cord during surgery may reduce blood flow due to edema and vasoconstriction. This can lead to testicular atrophy. The study aims to review current knowledge of testicular vascular impairment following IHR in children. METHODS A systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, and Web of Science. Methodological quality was assessed using validated tools. Data were extracted, and a pooled data analysis was performed. RESULTS Ten studies were included in the systematic review. Six of these studies were eligible for meta-analysis. This revealed a significant decrease in testicular vascularization during the short-term follow-up (1 day-1 week) after IHR using the open surgical approach. This decrease was not present after laparoscopic intervention. There was no more increased resistance in the vessels at long-term follow-up (1 month-6 months), suggesting that the impaired vascularity is only temporary. CONCLUSIONS There seems to be a short-term transient vascular impairment of the testis after open IHR in children. This might be of clinical relevance to prefer the laparoscopic approach for IHR in children, even though the open approach is the gold standard, in contrast to adult IHR. The impact on testicular function and sperm quality later in life remains unclear. Comparative studies of both techniques are needed to determine if there is a significant difference in testicular vascularity. Long-term studies are necessary to assess the impact of transiently reduced vascularity on sperm quality and fertility later in life.
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Affiliation(s)
- Roxanne Eurlings
- Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences (FHM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Rianne E. M. Killaars
- Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences (FHM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Ruben G. J. Visschers
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (Maastricht University Medical Center+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Wim G. van Gemert
- Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences (FHM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
- European Consortium of Pediatric Surgery (Maastricht University Medical Center+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Petridou M, Karanikas M, Kaselas C. Laparoscopic vs. laparoscopically assisted pediatric inguinal hernia repair: a systematic review. Pediatr Surg Int 2023; 39:212. [PMID: 37269352 DOI: 10.1007/s00383-023-05492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
This systematic review aims to compare the two major principles of laparoscopic pediatric inguinal hernia repair: totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR), to find out the optimal approach for pediatric patients. A systematic literature search was performed via Pubmed, Embase MEDLINE, and Cochrane databases on all studies published in the last 20 years reporting outcomes on these principles including recurrences, complications, and operative time. Prospective studies for either principle or retrospective comparative studies were considered eligible. Fischer's exact and Student's t test were used for statistical analysis with p value < 0.05 considered statistically significant. Twenty-one studies, including two thousand one hundred and ninety-six patients (LR: 1008), of ages ranging from 9 days to 18 years-old and a male to female ratio of 2.55:1, met our inclusion criteria. Follow-up period varied from 3 months to 8 years. Recurrence rates were similar between the two categories (LR: 1.68% vs. LAR: 1.59%, p > 0.05). As regards post-operative complications, transient hydrocele development was higher in laparoscopic repairs (LAR: 1.01% vs. LR: 3.17% p < 0.005) while wound healing problems were more frequent in laparoscopically assisted repairs (LAR: 1.17% vs. LR: 0.30%, p = 0.019). Mean operative time was lower in laparoscopically assisted repairs both in unilateral (LAR: 21.49 ± 13.51 vs. LR: 29.73 ± 11.05, p = 0.131) and bilateral cases (LAR: 28.01 ± 15.08 vs. LR: 39.48 ± 16.35, p = 0.101) but without statistically significant difference. Both principles are equally effective and safe as their recurrence and overall complications rates are equivalent. Transient hydrocele occurs more often in laparoscopic repairs while wound healing problems are associated mostly with laparoscopically assisted repairs.
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Affiliation(s)
- Maria Petridou
- Pediatric Surgery Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Michael Karanikas
- General Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Kaselas
- 2nd Department of Pediatric Surgery, "Aristotle" University of Thessaloniki Medical School, "Papageorgiou" General Hospital, Thessaloniki, Greece.
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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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Needle consideration in umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis of children: hook-needle or forcep-needle. BMC Surg 2022; 22:411. [PMID: 36461067 PMCID: PMC9716759 DOI: 10.1186/s12893-022-01866-8] [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] [Received: 08/10/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although umbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency of children has been verified to be safe and effective, the improvements of technical skills and instruments have been always on their ways. Recently, forcep-needle has begun to be used. In this study, we compared forcep-needle with hook-needle in this minimal invasive procedure for children suffered from hernia or hydrocele, with the aim to evaluate the instrumental convenience of the two needles. METHODS From July 2021 to May 2022, we begun to use hook-needle or forcep-needle in umbilical two-port laparoscopic percutaneous extraperitoneal closure for children suffered from hernia or hydrocele. The hook-needle group included nineteen children and the forcep-needle group included twenty-four ones. The data of the patients age, sex, side, operation time, postoperative hospital-stay, follow-up time, postoperative complications were evaluated. Common silk thread was used to encircle the internal ring preperitoneally. RESULTS There were no statistical differences between the two groups for the following items: age, sex, side, operation time, postoperative hospital-stay and postoperative complications (P > 0.05). The follow-up time of the hook-needle group was longer than that of the forcep-one (P = 0.0020). No open transfer happened for all the patients. One hydrocele boy in the hook-needle group reoccurred 1 month postoperatively due to the peritoneal broken. The single pole retreating of the hook-needle accompanied with chaotic movements, while for that of the forcep-needle, the double-arm retreating movements were more orderly. The outer surface of the forcep-needle was smooth without restrain, as for the hook-needle, an inlaid barb held the danger of brokening the peritoneum. CONCLUSION In our preliminary experience of umbilical two-port laparoscopic percutaneous extraperitoneal closure using a hook-needle or a forcep-needle, in view of the instrumental convenience and safety, the double-arm and smooth outer surface designs of the forcep-needle contained more spatial orientation perceptions and safety.
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Wu S, Xing X, He R, Zhao H, Zhong L, Sun J. Comparison of laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure versus open repair for pediatric inguinal hernia. BMC Surg 2022; 22:334. [PMID: 36085145 PMCID: PMC9461258 DOI: 10.1186/s12893-022-01787-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Laparoscopic-assisted repairs for pediatric inguinal hernia have gained gradual acceptance over the past decade. However, consensus about the optimal management is still lacking. The aim of this study is to compare outcomes of a modified laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) versus open repair of pediatric hernias/hydrocele in a single institution. Materials and methods We retrospectively reviewed the medical data of children who underwent laparoscope-assisted single-needle LPEC and open repair (OR) for inguinal hernia from 2014 to 2019. Data collection included demographics, laterality of hernia, surgical time and time to follow-up. We also reviewed and analyzed the evidence of recurrence, the incidence of metachronous contralateral inguinal hernia (MCIH), and other complications. Results In our cohort, 961 patients in the OR group and 1098 patients in the LPEC group were analyzed retrospectively. Mean operative time was significantly shorter in the LPEC group (22.3 ± 3.5 min) than in the OR group (27.8 ± 5.9 min) for bilateral hernia repair (p < 0.001). Postoperative recurrence was 1.3% (13/1035) in the OR group and 0.5% (6/1182) in the LPEC group (p = 0.056). Iatrogenic cryptorchidism occurred statistically more frequently in the OR group than in the LPEC group (0.4% vs. 0%, p = 0.013). In addition, the incidence of MCIH was 3.7% (33/887) in the OR group and 0.3% (3/1014) in the LPEC group (p < 0.01). Conclusion Comparing to open technique, laparoscope-assisted single-needle LPEC provides a simple and effective option for pediatric inguinal hernia/hydrocele repair with excellent outcomes, a low incidence of recurrence, and reduced MCIH.
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A case of bilateral inguinal hernia associated with Marfan syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bada-Bosch I, Escolino M, De Agustín JC, Esposito C. Pediatric Inguinal Hernia Repair, Laparoscopic Versus Open Approach: A Systematic Review and Meta-Analysis of the Last 10-Year Evidence. J Laparoendosc Adv Surg Tech A 2022; 32:583-594. [PMID: 35235432 DOI: 10.1089/lap.2021.0690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone.
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Affiliation(s)
- Isabel Bada-Bosch
- Department of Paediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Escolino
- Department of Paediatric Surgery, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Juan Carlos De Agustín
- Department of Paediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ciro Esposito
- Department of Paediatric Surgery, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
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Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Kanamori D, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. Risks and benefits of pediatric inguinal hernia repair: Conventional open repair vs laparoscopic percutaneous extraperitoneal closure. Asian J Endosc Surg 2022; 15:290-298. [PMID: 34605204 DOI: 10.1111/ases.12997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Considerable debate exists regarding the benefits of laparoscopic percutaneous extraperitoneal closure (LPEC) over conventional open repair (OR). We assessed the outcomes and feasibility of LPEC compared to OR for pediatric inguinal hernia (IH). METHODS We retrospectively analyzed 570 children who underwent LPEC or OR. Parents decided the operative method after obtaining informed consent. Patient characteristics, operative time, complications and contralateral metachronous IH (CMIH) were compared between the groups. RESULTS A total of 329 children underwent LPEC and 241 underwent OR. There was no significant difference in the incidence of recurrence or testicular ascent between the LPEC and OR groups (0.3% vs 0.4%, P = 0.825, 0.3% vs 0.8%, P = 0.391, respectively). No testicular atrophy was recognized in either group. One patient with postoperative chronic inguinal pain was recognized in each group. There was no surgical site infection (SSI) in the OR group; however, the LPEC group more frequently demonstrated umbilical port site (UPS)-related complications, such as incisional hernia, minor deformity, granuloma formation, cellulitis and superficial SSI. Ten (4.1%) developed CMIH in OR; in contrast, no case of CMIH was experienced after LPEC (P < 0.001). CONCLUSION In conclusion, both LPEC and OR are feasible in the management of pediatric IH, because of their high success rates and low risk of complications. LPEC could be the superior procedure with respect to the prevention of CMIH. However, to maximize the merits of LPEC over OR, it is important to reduce UPS-related complications in LPEC. A longer follow-up is needed to assess male fertility in patients who receive LPEC.
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Affiliation(s)
- Masashi Kurobe
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.,Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tetsuro Sugihara
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Atsushi Harada
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Sayuri Kaji
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Goki Uchida
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Daisuke Kanamori
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Yuji Baba
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tomomasa Hiramatsu
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Shinsuke Ohashi
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
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Okunobo T, Nakamura H, Yoshimoto S, Satake R, Shigeta Y, Doi T. The detail profile of cause of recurrences after laparoscopic percutaneous extraperitoneal closure (LPEC) in children: a systematic review. Pediatr Surg Int 2022; 38:359-363. [PMID: 34999940 DOI: 10.1007/s00383-021-05060-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Laparoscopic repairs for children with inguinal hernia have been established with various technical modifications. Laparoscopic percutaneous extraperitoneal closure (LPEC) is one of the most recognized techniques. Although the rate of complications of LPEC is similar to conventional repairs, the major cause of recurrence is still incompletely understood. The purpose of this study is to evaluate detail profile of the cause of recurrence in children treated with LPEC. METHODS A systematic literature search was performed using the combinations of the following terms "pediatric inguinal hernia", "LPEC", "complication", and "recurrence" for studies published between 2002 and 2020. The relevant cohorts of recurrence of LPEC in children were systematically searched for clinical outcomes. RESULTS 35 studies met defined inclusion criteria, reporting a total of 121 patients who had recurrence after LPEC. The mean age at primary operations was 46.7 ± 52.0 months. The gender proportions were 63.9% (male) and 36.1% (female). The rate of treatment side was 44.5% (right), 37.0% (left) and 18.5% (bilateral). The hernia sac was closed with absorbable suture materials (5.3%) and non-absorbable (94.7%). The recurrence occurred in 6.9 ± 8.5 months postoperatively. Operative findings of reoperation were loosening of the knot of internal rings (61.1%), low ligation of the inguinal canal (16.7%), and skipping (22.2%). CONCLUSIONS This study suggests that male infants have a higher risk of recurrence after LPEC, and the majority of recurrences can occur in a year postoperatively. It is important to confirm carefully that the suture is tight and high without skipping.
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Affiliation(s)
- Tokiko Okunobo
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan
| | - Hiroki Nakamura
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan
| | - Sakiko Yoshimoto
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan
| | - Ryosuke Satake
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan
| | - Yusuke Shigeta
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan
| | - Takashi Doi
- Department of Pediatric Surgery, Kansai Medical University, Osaka, Japan.
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Risk factors for metachronous contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for unilateral inguinal hernia in children. Surg Today 2022; 52:1491-1496. [PMID: 35211805 DOI: 10.1007/s00595-022-02480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
PURPOSES We use the laparoscopic percutaneous extraperitoneal closure (LPEC) method as the standard procedure for pediatric inguinal hernia. Despite judging there to be no contralateral patent processus vaginalis (PPV) at the time of the first LPEC, we experienced five cases in which metachronous contralateral inguinal hernia (MCH) developed, so we report the characteristics, including the predictors. METHODS For pediatric inguinal hernia, the LPEC method was used in 1277 cases from 2005 to 2019 in our department. Of these, 374 patients underwent unilateral LPEC, and we compared the 5 patients with MCH onset and the 369 without MCH onset. The items to be examined were the gender, age, presence of a low birth weight, initial-onset side, and contralateral internal inguinal ring classification. RESULTS There was no significant difference in the gender, age, initial-onset side, or contralateral internal inguinal ring classification between the two groups. Low-birth-weight infants were significantly more common among those with MCH than among those without MCH. CONCLUSIONS The only predictor of a contralateral onset after LPEC for pediatric inguinal hernia was a low birth weight. Therefore, for the above-mentioned unilateral LPEC cases, the possibility of a contralateral onset after LPEC due to acquired factors rather than congenital factors should be considered.
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Tanaka K, Mikami T, Ebata Y, Kato H, Miyano G, Ishii J, Okazaki T. Umbilical microflora and pediatric surgery. Pediatr Surg Int 2022; 38:345-349. [PMID: 34586482 DOI: 10.1007/s00383-021-05026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In pediatric surgery, the umbilicus with humid environment prone to bacterial colonization has become the most common site of entrance into the peritoneum. However, the umbilical flora in children has never been reported. This study aimed to describe the characteristics of umbilical microflora in children before antiseptic skin preparation. PATIENTS AND METHODS We prospectively reviewed all children (age, ≤ 15 years) undergoing surgical procedures using umbilical access between April 2020 and June 2021. Before antiseptic skin preparation, culture swabs were taken from the umbilicus. Data on age, sex, and surgical procedure as well as microflora results and clinical findings were analyzed. RESULTS Overall, data on 123 children aged between 9 days and 15 years (median: 3 years) were obtained. In the umbilicus, the most frequent colonizing bacteria were coagulase-negative Staphylococcus species and Corynebacterium. The isolation of intestinal bacteria from children aged ≤ 3 years was significantly increased (P = 0.03). The results of the multidrug resistance test revealed that the bacteria from the umbilicus exhibited a high frequency of cefazolin (CEZ) resistance (46.1%). No postoperative surgical site infection was recorded in our study. CONCLUSIONS This prospective study is the first report to investigate the umbilical microflora in over 100 children. In this study, a large spectrum of both resident and transient microflora was cultured from the umbilicus. This umbilical microflora was similar to previous reports of adult microflora except in children aged ≤ 3 years. Our data suggest that in children ≤ 3 years, preoperative and postoperative antibiotics should be chosen by considering CEZ resistance and intestinal bacteria. The result of umbilical microflora would be useful to select the antibiotics for treatment of surgical site infection (SSI), and the culture swabs from the umbilicus before the operation for the children at high risk for SSI are highly recommended.
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Affiliation(s)
- Keiichiro Tanaka
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Takafumi Mikami
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Yu Ebata
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Haruki Kato
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Go Miyano
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Junya Ishii
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
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Kart Y, Ozturk C. Comparison of Inguinal Herniotomies with and Without Opening the External Oblique Aponeurosis in Children Above the Age of Two. Niger J Clin Pract 2022; 25:33-36. [PMID: 35046192 DOI: 10.4103/njcp.njcp_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Mitchell-Banks technique (MBT), in which inguinal canal is not opened, usually used in inguinal hernia repair in children under 2 years of age. The majority of pediatric surgeons tend to open the inguinal canal while performing inguinal hernia surgery in children over 2 years of age, called as modified Ferguson herniotomy (FH). Aims This study aimed to compare early and late complications of the MBT and FH in over 2 years of age patients who underwent inguinal hernia surgery. Patients and Methods We retrospectively reviewed the medical records of all children between 2 and 16 years old who underwent inguinal herniotomy procedure using the MBT and FH between January 2013 and December 2019. Patients were evaluated in terms of demographic data, early and late complications. Results This study included 834 children. Of these, 379 (44.8%) were operated on by an FH with opening the inguinal canal (Group 1), and 455 (55.2%) by MBT superficially to the external ring (Group 2). There were 68 (17.9%) females and 311 (82.1%) males in group 1, while there were 151 (33.2%) females and 304 (66.8%) males in group 2. Early complications were wound infection (1.1% in the group 1 vs. 1.3% in the group 2, P = 1.00) and scrotal hematoma (1.3% vs. 1.8%, P = 0.89). Late complications included recurrence (1.6% in the group 1 vs. 1.8% in the group 2, P = 0.12), undescended testis (2.1% vs. 0.7%, P = 0.71), testicular atrophy (1.5% vs. 0.4%, P = 0.79), and hydrocele (1.9% vs. 1.8%, P = 0.87). There was no statistically significant difference in terms of early and late complications ratio between two groups. Conclusion This study showed that inguinal hernia repair performed without opening the inguinal canal in children older than 2 years do not lead to an increase in complications. In this respect, MBT can be used as a simple and safe procedure in older children.
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Affiliation(s)
- Y Kart
- Department of Pediatric Surgery, Süleyman Demirel University Medical Faculty, Isparta, Turkey
| | - C Ozturk
- Kartal Dr. Lütfi Kırdar City Hospital, Clinics of Pediatric Surgery, İstanbul, Turkey
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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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14
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Ergün E, Yağız B, Alper Kara Y, Nur Abay A, Balcı Ö, Eryılmaz S, Faruk Özgüner İ, Karaman A, Karaman İ. Comparison of laparoscopic percutaneous internal ring suturing method and open inguinal hernia repair in children under 3 months of age. Turk J Surg 2021; 37:215-221. [DOI: 10.47717/turkjsurg.2021.5157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022]
Abstract
Objective: Laparoscopic inguinal hernia repair in younger infants has not been completely accepted worldwide. The aim of this study was to evaluate the safety and feasiblity of laparoscopic percutaneous internal ring suturing method in children aged younger than 3 months and compare the recurrence and complication rates with open repair; which may still be mentioned as the gold standard procedure.
Material and Methods: A total of 387 children underwent inguinal hernia repair in the clinic between 2016 and 2019. One hundred and forty of them were under 3 months old and divided into two groups; children who underwent laparoscopic percutaneous internal ring suturing (Group 1) and open surgery (Group 2). Selection of the surgical method was regardless of weight, sex or any patient characteristics other than surgeon’s choice. Operation durations, complications and recurrences were compared between the two groups.
Results: A total of 140 patients underwent surgery due to inguinal hernia. Group 1 included 85 and Group 2 included 55 children. There were two recurrences in each group (p> 0.05). Operative durations were shorter in Group 1 for both; unilateral and bilateral repairs (< 0.0001). There were no intraoperative complications in any group. There was one major postoperative complication in Group 2: iatrogenic undescended testis, and none was observed in Group 1. In the laparoscopic group, 47% of the children who were diagnosed to have unilateral hernia were revealed to have bilateral inguinal hernias (n= 31).
Conclusion: Laparoscopic percutaneous internal ring suturing method seems favourable in terms of operative time. It also has the advantage of detecting contralateral patent processus vaginalis or asymptomatic contralateral inguinal hernia.
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15
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Johnson KN, Criss CN, Hirschl RB, Ladino-Torres M, Yang D, Jarboe MD. Ultrasound-guided pediatric inguinal hernia repair. J Pediatr Surg 2021; 56:1240-1245. [PMID: 33812656 DOI: 10.1016/j.jpedsurg.2021.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Inguinal hernias are amongst the most common surgical conditions in children. Typically, these repairs are performed through an open or laparoscopic approach, using a high ligation of the hernia sac. The use of ultrasound has been described in identifying and evaluating hernia contents in children. Our goal was to determine if ultrasound guidance could be used to perform a high ligation of the hernia sac in pediatric patients. METHODS Following IRB approval, a retrospective review of all female patients at a single center undergoing ultrasound guided inguinal hernia repair between 2017 and 2018 was performed. Pre-operative characteristics, intra-operative outcomes, and post-operative outcomes were all evaluated. Laparoscopy was used to evaluate the repair and evaluate for a contralateral hernia. Male patients did not undergo ultrasound inguinal hernia repair to avoid damage to the vas deferens and vessels. RESULTS A total of 10 patients with 13 hernias total were found during the study period. A total of one patient was converted to a laparoscopic repair. No patients were found to have an inappropriate repair or a missed contralateral hernia, and there were no vascular injuries or injuries to surrounding structures. No patients had a hernia recurrence during the study period. CONCLUSION This study demonstrates the safety and feasibility of ultrasound guided inguinal hernia repairs in female pediatric patients. Further study is needed to compare these repairs to existing techniques, evaluate for recurrences over time, and evaluate if these repairs can be performed without general anesthetic in some patients.
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Affiliation(s)
- Kevin N Johnson
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Cory N Criss
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109
| | - Maria Ladino-Torres
- Department of Pediatric Radiology, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor MI USA 48109
| | - Daniel Yang
- Michigan Medical School, Ann Arbor MI USA 48109
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109; Department of Interventional Radiology, Michigan Medicine, Ann Arbor MI USA 48109.
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16
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Liu J, Tang R, Wang X, Sui B, Jin Z, Xu X, Zhu Q, Chen J, Ma H, Duan G. Laparoscopic vs. Open Repair Surgery for the Treatment of Communicating Hydrocele in Children: A Retrospective Study From a Single Center. Front Surg 2021; 8:671301. [PMID: 34055871 PMCID: PMC8149793 DOI: 10.3389/fsurg.2021.671301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study evaluated the outcomes of laparoscopic repair (LR) and open repair (OR) surgery for communicating hydrocele in children. Patients and Methods: We collected the clinical data and follow-up data of all boys (<14 years) who underwent communicating hydrocele surgery in the pediatric surgery department at Yijishan Hospital of Wannan Medical College from January 2017 to December 2018 and retrospectively analyzed the data. Results: In this study, 155 patients were retrospectively enrolled, including 90 patients in the OR group and 65 patients in the LR group. There were significant differences in operation time and the recurrence of hydrocele between the two groups. The persistence of scrotal swelling in the LR group was significantly lower than that in the OR group. There was no significant difference in postoperative hospitalization time or incision infection rate between the two groups. Conclusion: In conclusion, this study shows that laparoscopic treatment of children with communicating hydrocele has the advantages of a hidden incision, a shortened operation time, and a reduced postoperative recurrence rate and can be used as the preferred surgical method. However, laparoscopic treatment should be selected according to the specific condition of each child and cannot completely replace traditional open surgery.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Rui Tang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xiao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bangzhi Sui
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Zhiyuan Jin
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xudong Xu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Qinghua Zhu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Jin Chen
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Honglong Ma
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
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Duan S, Zhang P, Lin X, Zheng L. Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement repair for pediatric inguinal hernia: a single-center experience with over 2,000 patients. Transl Pediatr 2021; 10:1317-1323. [PMID: 34189089 PMCID: PMC8192996 DOI: 10.21037/tp-21-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Inguinal hernia is one of the common diseases in infants and children that requires operative treatment. Laparoscopic inguinal hernia repair in children has become an alternative to the open procedure. Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement (LPECPR) is a safe and effective approach for pediatric inguinal hernia, and has a lower recurrence. This is a retrospective study to present our experience with children who underwent LPECPR. METHODS A total of 2,018 patients with inguinal hernia who underwent LPECPR in our hospital from July, 2011 to December, 2020 were reviewed. The surgical technique is modified on the basis of laparoscopic percutaneous extraperitoneal closure (LPEC) to close extraperitoneally by circuit suturing twice around the internal inguinal ring. RESULTS All cases were completed LPECPR without conversion. There were no intraoperative complications. A total of 2,018 patients' laparoscopic procedures were achieved. The mean operative time was 14 and 20 min for unilateral and bilateral operations, respectively. Follow-up to date is 13.4 months (6-36 months), there were no postoperative complications, such as knot reactions, hydrocele formation, testicular atrophy or pain, except 3 recurrences (3/2,018, 0.15%). CONCLUSIONS This modified LPECPR technique can acquire lower recurrence rate for repair pediatric inguinal hernia. The midterm safety and efficacy of LPECPR are proven and it can be a routine procedure.
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Affiliation(s)
- Shouxing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peijian Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaobin Lin
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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18
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Ohba G, Takahashi R, Okada N, Minato M, Nakayama M, Yamamoto H. Double ligation is useful to prevent recurrence for paediatric inguinal hernia in the laparoscopic percutaneous extraperitoneal closure procedure. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Go Ohba
- Department of Surgery Tenshi Hospital Sapporo Japan
| | | | - Naoki Okada
- Department of Surgery Tenshi Hospital Sapporo Japan
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19
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Shibuya S, Imaizumi T, Yamada S, Yoshida S, Yamada S, Toba Y, Takahashi T, Miyazaki E. Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis. Surg Endosc 2021; 36:941-950. [PMID: 33616732 DOI: 10.1007/s00464-021-08354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a number of studies comparing laparoscopic inguinal hernia repair (LH) and open herniorrhaphy (OH), the putative advantage of LH remains controversial due to a paucity of firm evidence. We hypothesized that LH has both advantages and disadvantages compared to OH and sought to clarify them by comprehensively analyzing the retrospective data using the combination of multiple statistical methods. METHODS Operative data for inguinal hernia during the period from February 1999 to December 2019 were examined. The patients were assigned into two groups according to the surgical procedure: laparoscopic percutaneous extraperitoneal closure (LPEC, n = 2410) and OH (n = 2038). Operative and anesthesia times and incidence of postoperative complications were evaluated using the propensity score methods and log-rank test. RESULTS In comparison with OH, operative time of LPEC was longer for unilateral repair (21.59 ± 8.1 min vs 18.01 ± 8.0 min; p < 0.001) and shorter for bilateral repairs (28.55 ± 10.1 min vs 33.23 ± 11.7 min; p < 0.001), while anesthesia times were longer for both unilateral repair (57.67 ± 10.1 min vs 40.62 ± 11.9 min; p < 0.001) and bilateral repairs (65.95 ± 12.5 min vs 56.35 ± 15.1 min; p < 0.001). LPEC significantly reduced the risk of metachronous contralateral hernia (MCLH) (0.52% vs 9.29%; p < 0.001), but the recurrence rate was higher (0.21% vs 0.04%; p = 0.002) than OH. Orchiectomy due to testicular atrophy or torsion was required in 3 cases of OH (0.19%), whereas it was not seen in LPEC. CONCLUSIONS LPEC had a less risk of MCLH and testicular complications but was associated with a higher recurrence rate and longer anesthesia time. Propensity scoring techniques can enhance the robustness of retrospective comparisons between groups over several years of data collection, which is frequently required in pediatric surgery studies.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Takaaki Imaizumi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Susumu Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shiho Yoshida
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shunsuke Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshie Toba
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Toshiaki Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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20
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Obayashi J, Wakisaka M, Tanaka K, Furuta S, Ohyama K, Kitagawa H. Risk factors influencing ascending testis after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Pediatr Surg Int 2021; 37:293-297. [PMID: 33388952 DOI: 10.1007/s00383-020-04789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the risk factors influencing ascending testis following laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia or hydrocele. METHODS Boys undergoing LPEC between 2014 and 2018 had their medical records and operative movies reviewed. Group A patients required orchiopexy after LPEC. Group B patients did not. Their baseline characteristics were reviewed. The path of the LPEC needle (not crossing the spermatic duct at first circuit [Not Crossing]), whether the second entry of the LPEC needle was different from the first hole (Different Hole), peritoneal injury requiring re-ligation (Re-ligation), and hematoma (Hematoma) were evaluated. The quantitative factors of significant difference were set as a cut-off value. RESULTS There were 5 patients (7 sides) in Group A and 162 patients (237 sides) in Group B. Birth weight was lower in Group A (p = 0.035). Not Crossing was 7 sides (100%) in Group A and 97 sides (41%) in Group B (p = 0.002). Hematoma was 2 sides (29%) in Group A and 11 sides (5%) in Group B (p = 0.047). Cut-off value of birth weight was 932 g (AUC 0.78). CONCLUSION Birth weight < 932 g and operative findings (not crossing over the spermatic duct on the first circuit and hematoma) indicated an increased risk of ascending testis after LPEC.
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Affiliation(s)
- Juma Obayashi
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Munechika Wakisaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Kunihide Tanaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
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Fazeli A, Davari HA, Hosseinpour M. A Modified Approach for Single-Port Laparoscopic Repair of Inguinal Hernias in Children. Adv Biomed Res 2020; 9:63. [PMID: 33457346 PMCID: PMC7792869 DOI: 10.4103/abr.abr_80_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/20/2020] [Accepted: 07/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Although traditional open groin incision repair has been used routinely for decades, the benefit of the minimally invasive surgery has challenged the traditional open method. Nowadays, laparoscopic herniorraphy has evolved to making it more minimally invasive from 3 to 2 and now single port and from intracorporeal to extracorporeal knotting. This study aimed to evaluate a new modification of single port laparoscopic herniorraphy in children with congenital inguinal hernia. Materials and Methods: In this single-institution randomized case–control study 190 children who suffered from congenital inguinal hernia were divided into two groups randomly: Group 1 (N = 73) undergone a single-port modified extracorporeal purse-string sutures (laparoscopic surgery [LS]) and Group 2 (N = 117) undergone open surgery (OS). Results: The mean age of the patients at operation time was 28.79 ± 11.45 months. Overall, three patients (1.57%) had intraoperative retroperitoneal hemorrhage. The duration of anesthesia and operation for those undergoing bilateral operation were significantly shorter in LS group. There was no statistically significant difference in individual postoperative complication rates between the groups. The proportion of overall post-operative complications was 4 (5.4%) in LS and 13 (11.1%) in OS group (P = 0.18). Proportion of trapped cryptorchidism was significantly higher in the OS group. Conclusion: In conclusion for children with inguinal hernia, we had found the benefits of single-port modified extracorporeal purse-string for reduction the operative time, trapped testes and better cosmetics and parents' satisfaction.
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Affiliation(s)
- Ali Fazeli
- Department of General Surgery, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Heidar Ali Davari
- Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Hosseinpour
- Department of General Surgery, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Miyano G, Yamada S, Barsness K, Tabata K, Takahashi T, Nakazawa-Tanaka N, Kusafuka J, Fukumoto K, Miyazaki E, Lane GJ, Okazaki T, Urao M, Urushihara N, Yamataka A. Can Intraoperative Video Recordings Contribute to Improving Laparoscopic Percutaneous Extraperitoneal Closure in Children with Inguinal Hernia and Prevent Recurrence? A Pilot Study. J Laparoendosc Adv Surg Tech A 2020; 30:1122-1126. [PMID: 32833567 DOI: 10.1089/lap.2020.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: We reviewed intraoperative video recordings (IVRs) of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia in children blindly to assess performance. Methods: IVRs of 183 LPEC performed between April 2013 and March 2016, graded by the operating surgeon as difficult (D; n = 8), straightforward (S; n = 96), or easy (E; n = 79), were scored by a panel of reviewers with advanced (group A; >400 LPEC cases; n = 5), intermediate (group I; 50-150 cases; n = 5), and basic (group B; <10 cases; n = 5) experience, according to suturing, dissection plane, vas/vessel dissection, bleeding, and peritoneal injury. They also allocated a recurrence risk rank (RRR; highest = 6; lowest = 1) for each IVR. Mean score variance for each IVR was also compared between reviewers. Results: There was one recurrence (R; 4-year-old male; level E). RRR were: 1, 2, and 2 for reviewers A, I, and B, respectively. Reviewer A scores for "suturing" and "bleeding," and reviewer I scores for "dissection plane" and "peritoneal injury" correlated significantly with RRR. No reviewer B scores correlated with RRR. Score variance between A and I and A and B for cases D1 and D2 were statistically significant. Conclusion: Advanced reviewers showed greatest variance, questioning the validity of whether experience alone improves surgical technique.
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Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shunsuke Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Katherine Barsness
- Department of Surgery and Medical Education, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Katsuhiro Tabata
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka City, Japan
| | | | - Junichi Kusafuka
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo Urayasu Hospital, Urayasu City, Japan
| | - Masahiko Urao
- Department of Pediatric Surgery, Juntendo Nerima Hospital, Tokyo, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka City, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Gong D, Qin C, Li B, Peng Y, Xie Z, Cui W, Lai Z, Nie X. Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia. Hernia 2020; 24:1099-1105. [PMID: 32266601 DOI: 10.1007/s10029-020-02180-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/25/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17 years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy. METHODS From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed. RESULTS All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15 min (8-25 min) for 557 unilateral hernias and 21 min (14-36 min) for 233 bilateral hernias. The mean postoperative stay was 20 h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42 months. No obvious scar was present postoperatively. CONCLUSION Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.
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Affiliation(s)
- D Gong
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - C Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - B Li
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China.
| | - Y Peng
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - Z Xie
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - W Cui
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - Z Lai
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - X Nie
- Department of Pediatric Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
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24
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Zhu H, Li J, Peng X, Alganabi M, Zheng S, Shen C, Dong K. Laparoscopic Percutaneous Extraperitoneal Closure of the Internal Ring in Pediatric Recurrent Inguinal Hernia. J Laparoendosc Adv Surg Tech A 2019; 29:1297-1301. [PMID: 31393202 DOI: 10.1089/lap.2019.0119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Haitao Zhu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jun Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xueni Peng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Mashriq Alganabi
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Chun Shen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
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Zenitani M, Saka R, Sasaki T, Takama Y, Tani G, Tanaka N, Ueno T, Tazuke Y, Oue T, Okuyama H. Safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernia in infants younger than 6 months: A comparison with conventional open repair. Asian J Endosc Surg 2019; 12:439-445. [PMID: 30561153 DOI: 10.1111/ases.12676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/30/2018] [Accepted: 11/04/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study aimed to compare the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR) for inguinal hernia in infants younger than 6 months. METHODS The medical records of 202 patients who had undergone LPEC or OR at an age younger than 6 months between 2010 and 2016 were reviewed. Patient characteristics and surgical outcomes were compared between LPEC and OR. RESULTS In total, there were 120 LPEC (76 males, 44 females) and 83 OR (76 males, 7 females) cases. There were no differences in median age, median bodyweight, and presence of incarceration between the two groups (LPEC group: 3 months (range, 0-5 months), 5.7 kg (range, 2.3-9.6 kg), and 13.3%; OR group: 3 months (range, 1-5 months), 5.5 kg (range, 2.1-9.0 kg), and 12.0%). LPEC was completed in all cases without any intraoperative complications or open conversions. In the LPEC group, 60.0% of unilateral hernia patients had a contralateral patent processus vaginalis and underwent prophylactic closure. The incidence of metachronous contralateral hernia was significantly lower in the LPEC group than in the OR group (0% vs 10.0%, P < 0.01). Operative time was significantly shorter during LPEC than during OR (P < 0.01) for male patients. The recurrence rate was lower in the LPEC group (0.83%) than in the OR group (2.4%), but the difference was not significant. CONCLUSION The present data indicate that LPEC is comparable to OR in terms of safety and efficacy in infants younger than 6 months. Moreover, among the LPEC group, there were fewer incidences of metachronous contralateral hernia, and the procedure had a shorter operative time.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryuta Saka
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sasaki
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Gakuto Tani
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Natsumi Tanaka
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review. Int J Surg 2019; 68:11-19. [DOI: 10.1016/j.ijsu.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/06/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
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Laparoscopic versus open repair for inguinal hernia in children: a retrospective cohort study. Surg Today 2019; 49:1044-1050. [PMID: 31312986 DOI: 10.1007/s00595-019-01847-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/14/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE We compared the outcomes of laparoscopic surgery (LS) with those of open surgery (OS) for unilateral and bilateral pediatric inguinal hernia. METHODS Using a nationwide claim-based database in Japan, we analyzed data from children younger than 15 years old, who underwent inguinal hernia repair between January 2005 and December 2017. Patient characteristics, incidence of reoperation, postoperative complications, length of hospital stay, and duration of anesthesia were compared between LS and OS for unilateral and bilateral hernia. RESULTS Among 5554 patients, 2057 underwent LS (unilateral 1095, bilateral 962) and 3497 underwent OS (unilateral 3177, bilateral 320). The incidence of recurrence was not significantly different between OS and LS (unilateral: OS 0.2% vs. LS 0.3%, p = 0.44, bilateral: OS 0.6% vs. LS 0.6%, p = 1.00). The incidence of metachronous hernias was significantly higher in the OS group than in the LS group (4.8% vs. 1.0%, p < 0.001). The surgical site infection rate was significantly lower after OS than after LS for unilateral surgeries (0.9% vs. 2.2%, p = 0.002). There was no difference between OS and LS in the length of hospital stay. CONCLUSION Both OS and LS had a low incidence of recurrence in children; however, the incidence of metachronous hernias was lower for LS, which may influence operative technique decisions.
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Ishikawa T, Nishikawa M, Nakamoto H, Yokoyama R, Taketomi A. Case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent girl with inguinal hernia in which open repair was effective. Asian J Endosc Surg 2019; 12:211-213. [PMID: 29956498 DOI: 10.1111/ases.12618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/12/2018] [Accepted: 06/06/2018] [Indexed: 01/15/2023]
Abstract
Chronic pain after laparoscopic percutaneous extraperitoneal closure is very rare. Here, we report a case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent patient with inguinal hernia who underwent open repair. A 15-year-old girl was diagnosed with a left indirect inguinal hernia, and laparoscopic percutaneous extraperitoneal closure was performed. However, 6 months later, after strenuous exercise, she developed localized pain around the hernia site. Her pain was well controlled by internal treatment but failed to completely resolve. The pain type was somatic, Tinel's sign was negative, and there was no recurrence of the inguinal hernia. Because she strongly wished to undergo surgery, the Potts procedure with removal of the ligature and excision of the round ligament was performed. Her pain improved after surgery, and further medical treatment was not required. The Potts procedure may be an effective treatment for chronic pain such as in this case.
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Affiliation(s)
- Takahisa Ishikawa
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Makoto Nishikawa
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Hiroki Nakamoto
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Ryoji Yokoyama
- Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperatives Abashiri-Kosei General Hospital, Abashiri, Japan
| | - Akinobu Taketomi
- Gastroenterological Surgery I, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: Analysis using a national inpatient database in Japan. J Pediatr Surg 2019; 54:577-581. [PMID: 29661573 DOI: 10.1016/j.jpedsurg.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence. RESULTS For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381-1350) days in LS and 1106 (576-1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70min, p<0.001) but shorter for bilateral surgery (86 vs. 96min, p<0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p<0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22-1.38; p=0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86-1.79; p=0.89). CONCLUSIONS LS patients had lower proportions of MH than OS patients. Complications and recurrence did not differ significantly between LS and OS. TYPE OF STUDY Retrospective study. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo.
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30
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Shibuya S, Miyazaki E, Miyano G, Imaizumi T, Mikami T, Ochi T, Koga H, Lane GJ, Okazaki T, Yamataka A. Comparison of laparoscopic percutaneous extraperitoneal closure versus conventional herniotomy in extremely low birth weight infants. Pediatr Surg Int 2019; 35:145-150. [PMID: 30390137 DOI: 10.1007/s00383-018-4386-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Laparoscopic percutaneous extraperitoneal closure (LPEC) has become routine for repairing pediatric inguinal hernia (IH). Reports on the effective repair of IH in challenging cases, such as extremely low birth weight infants (ELBWI) who become symptomatic soon after birth and have surgery before 1 year of age, are rare; and conventional herniotomy (CH) in ELBWI requires extensive experience of neonatal surgery. We compared LPEC with CH for treating ELBWI with IH. METHODS Consecutive ELBWI with IH treated by either LPEC (n = 17) or CH (n = 22) before 1 year of age between 2012 and 2017 were reviewed. LPEC were performed by consultant pediatric surgeons (CPS; n = 3) with experience of at least 200 cases each. In CH, 11 cases were treated by CPS and 11 by CPS-supervised surgical trainees. RESULTS There were no intraoperative complications. Operative time and anesthesia time for bilateral IH repairs were both shorter in LPEC. Postoperative sequelae were recurrence (LPEC; n = 1; repaired by redo LPEC 2 months after the initial repair) and intravenous rehydration (CH; n = 1; for persistent post-anesthetic vomiting). Recovery was unremarkable in all cases without additional analgesia. CONCLUSION LPEC would appear to be a viable option for treating IH in ELBWI, especially bilateral cases.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takaaki Imaizumi
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takashi Mikami
- Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo Urayasu Hospital, Chiba, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan
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31
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Kim Y. Characteristics and recent therapeutic trends of pediatric inguinal hernia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yeajeong Kim
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
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32
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Li S, Liu X, Wong KKY, Liu L, Li Y. Single-port laparoscopic herniorrhaphy using a two-hooked cannula device with hydrodissection. J Pediatr Surg 2018; 53:2507-2510. [PMID: 30227994 DOI: 10.1016/j.jpedsurg.2018.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopic percutaneous extraperitoneal closure (LPEC) with variable devices seems to be one of the most simple and reliable methods. We described our modifications of single-port laparoscopic herniorrhaphy using an inner two-hooked cannula device with preperitoneal hydrodissection. PATIENTS AND METHODS 1568 children with 2114 inguinal hernias were treated by single-port LPEC. Under laparoscopic visualization, the two-hooked cannula device carrying a silk suture was inserted at the point of the internal ring and could be readily kept in an identical path. The hernia orifice was completely lassoed extraperitoneally by the suture with the assistance of hydrodissection. Any huge hernias of more than 1.5 cm were repaired with the incorporation of medial umbilical fold flap as reinforcement. RESULTS All hernia repairs were successfully performed by LPEC. 1022 patients had unilateral inguinal hernia repair, and 546 patients underwent bilateral inguinal hernia repair. Of these, additional medial umbilical flap reinforcement was necessary in 68 cases, and an assisted grasping instrument was used in 19 cases owing to omental adhesion or sliding hernia. Mean operating times for unilateral and bilateral inguinal hernia repairs were 9.8 ± 2.1 min and 13.6 ± 2.2 min, respectively. There were no operative complications. Two recurrences and three hydroceles were observed during 6 to 30 months of follow-up. CONCLUSIONS One-puncture LPEC using the two-hooked cannula device with preperitoneal hydrodissection has proved to be a safe and effective procedure with excellent cosmetic results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Suolin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
| | - Xuelai Liu
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, China.
| | - Lin Liu
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yingchao Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
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Kangwen C, Guihe W. Efficacy of Laparoscopic Percutaneous Extraperitoneal Closure for Unilateral Inguinal Hernia in Children and Significance of Simple Exploration Maneuver for Contralateral Patent Processus Vaginalis: A Retrospective Study. Am Surg 2018. [DOI: 10.1177/000313481808400527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for unilateral inguinal hernia in children and effect of intraoperative laparoscopic exploration for finding contralateral patent processus vaginalis (CPPV) on prevention of the metachronous contralateral hernia (MCH). We retrospectively analyzed unilateral inguinal hernia ligation in children, which can be diveded into two groups: a total of 252 cases with open surgical ligation from January 2010 to December 2012 (open group), a total of 184 cases underwent laparoscopic percutaneous peritoneal hernia sac high ligation LPEC from January 2013 to March 2015 (LPEC group). Then, we observed postoperative complications, recurrence of hernia, and the postoperative MCH in the two groups and analyzed the influence factors of the MCH. In Open groups and LPEC groups, the complication incidences, respectively, were 4.4 and 1.6 per cent, having statistical difference ( P > 0.05), the average postoperative follow-up duration, respectively, were 42 months and 22 months, whereas the overall incidence of MCH, respectively, were 5.2 and 0.5 per cent ( P < 0.05). In the first 24 months follow-up time, the overall incidence of MCH, respectively, were 3.6 and 0 per cent. Laparoscopic evaluation was positive for CPPV in 67 cases. We found the prevalence of 56.1 per cent of CPPV in LPEC groups aged 0.6 to 2 years old, finding the incidence gradually decline with the increase of age, until 14.3 per cent to 10 to 12 years old group. Our study shows LPEC has proven efficacy in treatment of unilateral inguinal hernia in children, and routine laparoscopic exploration with this simple maneuver should be actively performed to observe CPPV in all chidren.
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Affiliation(s)
- Cheng Kangwen
- Department of Gastrointestinal Surgery, People's Hospital of Tongling City, Tongling, Anhui, People's Republic of China
| | - Wang Guihe
- Department of Gastrointestinal Surgery, People's Hospital of Tongling City, Tongling, Anhui, People's Republic of China
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Sonderman KA, Wolf LL, Armstrong LB, Taylor K, Jiang W, Weil BR, Koehlmoos TP, Ricca RL, Weldon CB, Haider AH, Rice-Townsend SE. Testicular atrophy following inguinal hernia repair in children. Pediatr Surg Int 2018; 34:553-560. [PMID: 29594470 DOI: 10.1007/s00383-018-4255-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children. METHODS We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005-2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis. RESULTS 8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1-5). Median follow-up was 3.57 years (IQR 1.69-6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children [Formula: see text] 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64-3), with 30% occurring within 1 year and 75% within 3 years. CONCLUSION Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later. LEVEL OF EVIDENCE Prognosis Study, Level II.
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Affiliation(s)
- Kristin A Sonderman
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA. .,Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Lindsey L Wolf
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA.,Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Wei Jiang
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Robert L Ricca
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Adil H Haider
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA.,Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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35
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Lin J, Li D, Chen J, Lin L, Xu Y. Inguinal hernia repair by Bianchi incision in boys: a retrospective study. Pediatr Surg Int 2018; 34:289-295. [PMID: 29188379 DOI: 10.1007/s00383-017-4217-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision. METHODS A total of 3300 boys (1-144 months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7 days, 1 month, and 1 year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated. RESULTS Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0 ± 2.3 min for unilateral cases and 25.2 ± 4.2 min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect. CONCLUSION Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.
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Affiliation(s)
- Junshan Lin
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Dumiao Li
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Jinwen Chen
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Li Lin
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Yali Xu
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China.
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Amano H, Tanaka Y, Kawashima H, Deie K, Fujiogi M, Suzuki K, Morita K, Iwanaka T, Uchida H. Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases. Surg Endosc 2017; 31:4988-4995. [PMID: 28597284 PMCID: PMC5715036 DOI: 10.1007/s00464-017-5472-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUD Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) has gained increased popularity for pediatric inguinal hernia repair. To improve cosmesis, we developed single incision LPEC (SILPEC). The aim of this study was to assess the safety and feasibility of SILPEC compared with traditional open repair (OR). METHODS This was a single-center retrospective cohort study of 2028 children who underwent inguinal hernia repair between April 2005 and August 2014. Nine hundred and ninety-five patients underwent OR and 1033 patients underwent SILPEC. Medical records were reviewed with respect to operative time, recurrence, incidence of contralateral metachronous inguinal hernia (CMIH), and complications. Patient satisfaction with cosmetic result was also investigated using questionnaires sent by mail. RESULTS All SILPEC procedures were completed without conversion. Operative time was longer in the SILPEC group than in the OR group for both unilateral and bilateral surgery regardless of sex (unilateral male: p = 0.0006, unilateral female: p < 0.0001, bilateral male: p < 0.0001, bilateral female: p < 0.0001). There was no statistically significant difference in recurrence rate (p = 0.43). The incidence of CMIH was significantly higher in the OR than in the SILPEC group (p < 0.0001). No postoperative testicular atrophy was found in either group. There was no statistically significant difference in ascending testis (p = 0.09), but the frequency of surgical site infection was higher in the SILPEC than in the OR group (p = 0.0013). According to the questionnaire, operative scar was more invisible in the SILPEC than in the OR group (p < 0.0001), but both procedures had equally high levels of satisfaction for cosmetic results (p = 0.58). CONCLUSION SILPEC proved to be a safe and feasible procedure compared with OR with an equally low recurrence rate, more effectiveness for preventing CMIH, and more invisible scar.
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Affiliation(s)
- Hizuru Amano
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan.,Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Michimasa Fujiogi
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Keisuke Suzuki
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
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Miyake H, Fukumoto K, Yamoto M, Nakajima H, Sekioka A, Yamada Y, Nomura A, Urushihara N. Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia. J Pediatr Surg 2017; 52:317-321. [PMID: 27894761 DOI: 10.1016/j.jpedsurg.2016.11.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has recently been increasing. Recurrence and contralateral metachronous inguinal hernia (CMIH) are important problems for LPEC. This study analyzed the risk factors for recurrence and CMIH. METHODS This study included 1530 patients. The mean follow-up period was 48months. Of 1530 patients, 847 were boys and 683 were girls. The mean age at operation was 3.9years. The asymptomatic contralateral internal ring was routinely observed during the operation, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed. RESULTS Recurrence was seen in 0.48% of patients (8/1653 sides), all of whom were male (P=0.01: male versus female). On multivariate analysis, age less than 1year was the only risk factor for recurrence in male patients (hazard ratio: 4.54, 95% CI: 1.07-19.25, P=0.04). CMIH was seen in 0.22% of the patients (3/1382), again only in male patients (P=0.12: male versus female). As a result of intraoperative observation, 44.6% of patients were confirmed to have an asymptomatic contralateral PPV and underwent prophylactic LPEC. Female, age 1year or older, right side, and surgeon's experience were identified as factors associated with asymptomatic contralateral PPV. CONCLUSIONS To prevent recurrence, surgeons need to be careful when operating on young male patients. Whereas no specific factor could be identified as a risk factor for CMIH, some factors associated with asymptomatic PPV were identified. Further study and discussion will be needed to identify correlations between CMIH and these factors for PPV. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hideaki Nakajima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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Wang F, Zhong H, Zhao J. Ascending testis after repair of pediatric inguinal hernia and hydrocele: A misunderstood operative complication. J Pediatr Urol 2017; 13:53.e1-53.e5. [PMID: 27727095 DOI: 10.1016/j.jpurol.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ascending testis (AT) is a rare complication after repair of an inguinal hernia/hydrocele. However, there has been some controversy concerning the AT following laparoscopic and open procedures. OBJECTIVE To review the experience of, and discuss the associated mechanisms with, testicular ascent after pediatric inguinal hernia/hydrocele surgery. STUDY DESIGN A retrospective review of the medical records of male children who underwent inguinal hernia/hydrocele repair at the present hospital between January 2000 and December 2014. Those who underwent subsequent orchiopexies due to ipsilateral cryptorchidism were identified. The ATs that were misdiagnosed, caused by improper operation, and retractile testes were excluded. The Poisson distribution evaluated the incidences of subgroups. RESULTS A total of 17,295 inguinal hernias and hydroceles were repaired on 12,849 males; of whom, 10 testes (0.058%) developed ATs on nine individuals postoperatively (Summary Table). The difference of AT incidences between subgroups was insignificant (P > 0.05), except for that grouped by the age at initial operation (cutoff = 1 year, P = 0.008; cutoff = 2 years, P = 0.012). During orchiopexy, extensive adhesions were found in the inguinal canal only in the two cases following open repair. The hernia sac/processus vaginalis remained intact in the canal of AT after laparoscopic repair, and partial after open herniotomy. DISCUSSION It was generally assumed that testicular ascent after repair of an inguinal hernia/hydrocele was caused by adhesion of the spermatic cord. However, the cord was not dissected during laparoscopic procedure, so adhesion was not the major reason for AT following laparoscopic surgery. The sac/processus were partially excised during open repair, but kept intact in laparoscopic procedure. Therefore, remnants of the sac/processus might play a greater role in postoperative testicular ascent than adhesions. Furthermore, it was found that AT incidence after the repair was not higher than that in 'normal' males. Ascending testis was probably not an operative complication, but a natural descent process of testis independent of the operation. Moreover, the testis descended further due to dissection of the cord and excision of the sac/processus, so the AT incidence was extremely low following open operation. From this point of view, open repair of an inguinal hernia/hydrocele was probably a protective factor for preventing testicular ascent. CONCLUSION Ascending testis is rare in male pediatric patients who have had repair of an inguinal hernia/hydrocele. Currently, the mechanism of testicular ascent is still unclear, and should be further investigated in the future.
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Affiliation(s)
- Furan Wang
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China.
| | - Hongji Zhong
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China
| | - Junfeng Zhao
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China
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