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Jinxiang L, Qingwei C, Shenghua Q, Yunqiang X, Haiyang L, Chengliang L, Meng X. Contralateral patent processus vaginalis repair in boys: a single-center retrospective study. Sci Rep 2022; 12:12073. [PMID: 35840606 PMCID: PMC9287543 DOI: 10.1038/s41598-022-15435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
To ascertain the prevalence of contralateral patent processus vaginalis (CPPV) in life and the significance of the prevalence trends for treatment. We performed a retrospective review of all inguinal hernias (IHs) that underwent repair in our hospital from 2014 to 2018. We analyzed the frequency of occurrence and treatment in boys. We assessed and compared the history, initial sides of hernia, CPPV and prognoses in different age groups. We assessed all IH cases repaired in our hospital and selected male patients of a variety of ages, including boys and men. Recurrent cases were not enrolled. A total of 3243 cases were enrolled: 2489 [right-sided IH 1411 (56.69%) vs. left-sided IH 975 (39.17%), bilateral IH 103 (4.14%)] in children and 754 [right-sided IH 485 (64.32%) vs. left-sided IH 236 (31.30%), bilateral IH 33 (4.38%)] in adults. A total of 1124 CPPVs were identified in children with unilateral IH (2386), and 12 were identified in adults (267) (p < 0.0001). There were no significant differences in recurrence rate between different subgroups of children (p > 0.05). The incidence of IH in boys was significantly higher than that in men. The number of incident cases declines rapidly with age in boys. The processus vaginalis is normally obliterated and involuted but may instead remain patent for a long period before closure; routine exploration on the contralateral side may eliminate the possibility of spontaneous PPV closure.
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Affiliation(s)
- Liu Jinxiang
- Master of Medicine, Linyi Central Hospital, Linyi, Shandong, China.
| | - Cao Qingwei
- Bachelor of Science in Medicine, Linyi Central Hospital, Linyi, Shandong, China
| | - Qiu Shenghua
- Bachelor of Science in Medicine, Linyi Central Hospital, Linyi, Shandong, China
| | - Xia Yunqiang
- Bachelor of Science in Medicine, Linyi Central Hospital, Linyi, Shandong, China
| | - Liu Haiyang
- Master of Medicine, Linyi Central Hospital, Linyi, Shandong, China
| | - Liu Chengliang
- Master of Medicine, Linyi Central Hospital, Linyi, Shandong, China
| | - Xu Meng
- Bachelor of Science in Medicine, Linyi Central Hospital, Linyi, Shandong, China
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The relationship between contralateral patent processus vaginalis and metachronous contralateral inguinal hernia in children with unilateral inguinal hernia: a prospective observational study. Hernia 2022; 26:1161-1168. [PMID: 35821302 DOI: 10.1007/s10029-022-02638-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Laparoscopic contralateral patent processus vaginalis (CPPV) repair in children is debatable due to the high CPPV rate, but low metachronous contralateral inguinal hernia (MCIH) rate. We conducted this study to find risk factors for MCIH. METHOD We conducted a prospective, observational trial with patients recruited from Shanghai Children's Hospital. Eligible participants were patients under 16 years old with unilateral inguinal hernia whose parents did not opt for simultaneous CPPV repair. The subjects were followed for 24 to 34.1 months. Patients who developed MCIH were analyzed to identify the relationship between CPPV and MCIH. RESULTS Between October 17, 2018, and July 31, 2019, we included 184 patients and 182 completed follow-up. MCIH occurred in ten patients, of which 7 (7.53%) had CPPV and three (3.37%) had no CPPV. Univariate analysis showed that age (p = 0.025, OR = 0.938) and CPPV diameter (p = 0.003, OR = 1.783) were related to the development of MCIH. In multivariate analysis, only diameter of CPPV (p = 0.008, OR = 1.411) was associated with MCIH. The receiver operating characteristic (ROC) curve was used to test, and it was found that when the diameter of CPPV was greater than 4 mm, the Youden index was the highest, with a specificity of 62.8% and a sensitivity of 100%. CONCLUSION The incidence of MCIH was not statistically higher in patients with CPPV compared with those without CPPV, so there is no indication for routine CPPV repair. The risk of MCIH development increases with CPPV diameter. 4 mm is the optimal cutoff point. Large CPPVs (> 4 mm) could be treated to prevent future hernias. TRIAL REGISTRATION The Chinese Clinical Trial Registry ( www.chictr.org.cn ), number ChiCTR2000041307.
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Wolak PK, Strzelecka A, Piotrowska - Gall A, Wolak PP, Piotrowska I, Dąbrowska K, Wróbel J, Nowak-Starz G. Percutaneous Internal Ring Suturing (PIRS) – The Benefits of Laparoscopic Inguinal Hernia Repair. Ther Clin Risk Manag 2022; 18:135-144. [PMID: 35237037 PMCID: PMC8882976 DOI: 10.2147/tcrm.s348197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery. Purpose The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques. Patients and Methods We conducted a retrospective study that included children aged 0–18 treated using the PIRS technique in 2008–2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method. Results The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia. Conclusion The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.
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Affiliation(s)
- Przemysław Karol Wolak
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
- Correspondence: Przemysław Karol Wolak, Tel +48 501 525 549, Email
| | | | - Aneta Piotrowska - Gall
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
| | | | | | - Katarzyna Dąbrowska
- Department of Neonatology and Neonatal Intensive Care, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Joanna Wróbel
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020321. [PMID: 35054015 PMCID: PMC8781267 DOI: 10.3390/jcm11020321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. SUMMARY BACKGROUND DATA Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. RESULTS Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: -11.90 min, 95% CI: -16.63 to -7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. CONCLUSIONS LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.
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Lee SR. Laparoscopic iliopubic tract repair to treat recurrent pediatric inguinal hernia. Surg Endosc 2022; 36:4321-4327. [PMID: 34694490 PMCID: PMC9085696 DOI: 10.1007/s00464-021-08776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Congenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH). However, in some patients, PIH occurs via acquired defects rather than congenital defects. The most representative cause of PIH is recurrent hernia. Recurrent PIH is treated with high ligation (HL), which is the same method that is used to treat primary PIH. However, the re-recurrence rate of recurrent PIH is high. This study aimed to compare laparoscopic iliopubic tract repair (IPTR) with laparoscopic HL for the treatment of recurrent PIH after primary PIH repair. METHODS From June 2013 to March 2019, 126 patients (< 10 years old) with recurrent PIH were retrospectively enrolled. Patients were divided into two groups according to the operative technique: laparoscopic HL (58 patients) and laparoscopic IPTR (68 patients). With HL, the hernial sac was removed and the peritoneum closed. With IPTR, iliopubic tract and transversalis fascia sutures were applied. RESULTS There were no cases of conversion to open surgery. Re-recurrence only occurred in the HL group; no patients in the IPTR group developed re-recurrence (8.6% [5/58] vs. 0.0% [0/68], respectively; p = 0.044). The mean duration from re-operation to re-recurrence in these five patients was 10.6 months. Other surgical outcomes and complications did not differ between the two groups. CONCLUSIONS Laparoscopic IPTR is an effective surgical treatment for reducing re-recurrence of recurrent PIH.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea
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Gollu G, Ates U, Bahadir K, Ergun E, Yagmurlu A, Cakmak M, Aktug T, Dindar H, Bingol-Kologlu M. Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children. J Pediatr Urol 2019; 15:561.e1-561.e6. [PMID: 31383517 DOI: 10.1016/j.jpurol.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal hernia repair is a common procedure in daily pediatric surgical practice. OBJECTIVES The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. STUDY DESIGN Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. RESULTS Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. DISCUSSION AND CONCLUSIONS TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.
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Affiliation(s)
- G Gollu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - U Ates
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - K Bahadir
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - E Ergun
- Sami Ulus Children's Hospital, Department of Pediatric Surgery, Ankara, Turkey
| | - A Yagmurlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Cakmak
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - T Aktug
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - H Dindar
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Bingol-Kologlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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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 repair of inguinal hernia in infants: Comparison with open hernia repair. J Pediatr Surg 2018; 53:2008-2012. [PMID: 29477445 DOI: 10.1016/j.jpedsurg.2018.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR). METHODS We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR. RESULTS In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8±10.4 vs. 51.1±14.4min, p<0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p=0.006). CONCLUSION LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia. LEVELS OF EVIDENCE Prognosis Study, Retrospective Study, Level III.
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Raveenthiran V, Agarwal P. Choice of Repairing Inguinal Hernia in Children: Open Versus Laparoscopy. Indian J Pediatr 2017; 84:555-563. [PMID: 28550349 DOI: 10.1007/s12098-017-2354-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/12/2017] [Indexed: 11/24/2022]
Abstract
Inguinal hernia is a common disorder of childhood that requires surgical repair at diagnosis. Traditionally, it is operated upon by open inguinal incision. However, with the introduction of laparoscopic repair in 1990, opinion of scientific community is divided concerning the best method of pediatric herniotomy. Educated parents, who long to have the choicest of the best, often gather information from internet and prefer to discuss their concerns with primary care physicians. This descriptive review is intended to provide practicing pediatricians with updated evidence-based information which will enable them to counsel parents regarding the choice of hernia repair. Based on careful analysis of current literature, unacceptable standards are defined in this paper and rationalized recommendations are proposed. Laparoscopy appears to be beneficial in bilateral hernia of girls, giant hernia, recurrence following failed open repair and in hernia associated with undescended testis or ambiguous genitalia. On the other hand, open herniotomy appears to be advantageous in male inguinal hernia, unilateral female hernia, premature newborns, failed laparoscopic repair and in hernia associated with serious co-morbidity.
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Affiliation(s)
- Venkatachalam Raveenthiran
- Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, Tamil Nadu, India.
| | - Prakash Agarwal
- Department of Pediatric Surgery, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
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