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Zhang H, Feng Y, Wang J, Zhao H. Comparison of Laparoscopic Percutaneous Extraperitoneal Internal Ring Closure by Two-Hook Hernia Needle and Open Repair for Pediatric Inguinal Hernia. J Laparoendosc Adv Surg Tech A 2023; 33:821-828. [PMID: 37311201 PMCID: PMC10440662 DOI: 10.1089/lap.2022.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Purpose: In children, pediatric inguinal hernia (PIH) is a prevalent condition. PIH is currently more frequently managed by laparoscopic closure of the hernia sac. We improved this minimally invasive technique; that is, laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure. Safety and effectiveness were evaluated by comparing the differences between laparoscopic repair (LR) and open repair (OR) in terms of operation time, surgical complications, contralateral metachronous hernia incidence, and recurrence rate. Methods: A retrospective clinical data analysis was performed on pediatric patients who had hernia surgery utilizing the LR or OR method between June 2019 and June 2021. Medical records of all of the children were gathered, and clinical traits, information about the procedure, and follow-up were all analyzed. Results: A total of 370 patients' inguinal hernias were repaired. For 136 patients undergoing OR and 234 patients undergoing LR, all procedures were completed satisfactorily. There were 98 cases of bilateral hernias and 272 cases of unilateral hernias (180 on the right side and 92 on the left). In the LR group, 58 patients who had been initially diagnosed with unilateral hernias developed contralateral occult hernias intraoperatively. Inguinal hernia operations took an average of 13.82 (LR) and 32.07 (OR) minutes for unilateral cases, and 21.00 (LR) and 54.85 (OR) minutes for bilateral cases. For LR and OR, the average follow-up time was 22.41 months and 23.10 months, respectively. The perioperative complications included peritoneal rupture in 3 patients, scrotal edema or hematoma in 5, hydrocele in 3, and groin pain in 6. In the LR group, 1 patient experienced the postoperative recurrence, whereas 8 individuals in the OR group did. Conclusions: Our initial research showed that laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure inguinal hernia repair is a safe and effective procedure. The LR method has the benefits of concealing the incision, a quicker procedure, having a lower risk of complications, and finding contralateral patent processus vaginalis. Therefore, promoting and using this surgical technique in clinical practice are merited. Clinical Trial Registration number: Medical Association of Xiangtan (2022-xtyx-28).
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Affiliation(s)
- Huaixiao Zhang
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Yuan Feng
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Jianguo Wang
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Hongjun Zhao
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
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Michler V, Elrod J, Wingtes K, Trah J, Reinshagen K, Boettcher M. Should the processus vaginalis sac be opened or closed in pediatric herniotomy? A two-center cohort study. Pediatr Surg Int 2022; 38:1165-1169. [PMID: 35666281 DOI: 10.1007/s00383-022-05145-8] [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: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children. METHODS Retrospective study including all cases of inguinal hernia repair in children at two large centers. Demographic data and outcome parameters including procedure time and intra as well as postoperative complications were evaluated. To compare open vs. closed hernia sack preparation, cases with secondary open preparation were excluded and propensity score matching was performed. Regression analysis was used to determine factors affecting operative time and recurrence rate. RESULTS In total 2476 cases of inguinal hernia repair were identified. After exclusion of direct hernias as well as revision cases, 2257 cases were analyzed. Overall mean operative time was 25.8 min. Intraoperative complications occurred in 0.1% and. postoperative complications occurred in 3.0% of all cases, the most frequent postoperative complication being recurrence (1.7%). Closed preparation technique resulted in significantly faster procedure time and lower recurrence rates in premature neonates and older children compared to the open hernia sac preparation technique. Operative technique, prematurity, gender and training of the surgeon are highly associated with operative time, whereas operative technique is the main factor affecting recurrence rate. CONCLUSIONS It appears that closed hernia sack preparation is superior to open regarding speed and recurrence. This was true for premature neonates, neonates and older children. All other outcome parameters including intra- and postoperative complications were similar. Thus, we recommend to use the closed preparation technique whenever possible.
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Affiliation(s)
- Veronika Michler
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristofer Wingtes
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Trah
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Arulanandam B, Selvarajan A, Piche N, Sheldon S, Bloom R, Emil S, Li P, Janvier A, Baird R, Sampalis JS, Haggerty J, Guadagno E, Daniel SJ, Poenaru D. Use of a risk communication survey to prioritize family-valued outcomes and communication preferences for children undergoing outpatient surgical procedures. J Pediatr Surg 2022; 57:788-797. [PMID: 35063255 DOI: 10.1016/j.jpedsurg.2021.12.033] [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] [Received: 12/05/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Effective shared decision-making in pediatric surgery requires clarity regarding which surgical outcomes are most important to patients and their families, and how they prefer to receive the information. Despite how essential this is for effective risk communication, little is known about the communication needs and preferences of patients and their families in elective pediatric surgery. METHODS We administered a mailed and online cross-sectional survey in English and French to 548 families before or after surgery for hernia/hydrocele repair or tonsillectomy/adenoidectomy between July 2019 and February 2021. The survey consisted of 22 questions eliciting most valued patient-reported outcomes (PROs) across 4 domains: health-related quality of life (5), functional status (5), symptoms and symptom burden (5), health behaviours and patient experience (7), as well as overall impressions (3), surgical risks (5), communication preferences (4), and demographic questions (16). RESULTS The survey was completed by 368 patient families (60 preoperative, 308 postoperative, response rate 67.2%). Most respondents (72%) indicated a significant desire to be informed on all listed PROs alongside surgical complications, and highly valued all functional and quality of life outcomes (92.9% & 89.8%, respectively). Preoperatively, patient families preferred to receive information in the form of pamphlets and websites, whereas postoperatively they preferred direct communication. CONCLUSION Families value functional and quality of life PROs as much as clinical outcomes, and increasingly seek more contemporary (electronic) means of risk communication than we currently offer. This data will inform the development of mobile tools for personalized communication in pediatric surgery.
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Affiliation(s)
- Brandon Arulanandam
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Arthega Selvarajan
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Nelson Piche
- Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Signy Sheldon
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Robert Bloom
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Patricia Li
- Division of General Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Annie Janvier
- Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada. Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montreal, QC, Canada
| | - Robert Baird
- Division of Pediatric General Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, Montreal, QC, Canada
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Ahmad HM, Naumeri F, Saud U, Butt G. Comparison of Ferguson and Gross herniotomy with Mitchell Banks' herniotomy in boys older than two years. Pak J Med Sci 2020; 37:40-44. [PMID: 33437248 PMCID: PMC7794118 DOI: 10.12669/pjms.37.1.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective In children younger than two years, most surgeons perform the inguinal herniotomy superficially through the external ring, a technique known as Mitchell-Banks' Herniotomy (MBH) while in older children, commonly Ferguson and Gross Herniotomy (FGH) is performed which involves opening of inguinal canal. Our aim was to compare the FGH and MBH in terms of recurrence in boys with inguinal hernia. Methods Boys with inguinal hernia presenting to Pediatric Surgery, Mayo Hospital Lahore from Dec 2016 to January 2018 were included in the study, if older than two years and younger than 14 years and without palpable deep ring (2 cm or more in width) or strangulation of inguinal hernia or malnutrition. They were randomly allocated in 2 groups after obtaining informed consent from parents, and underwent MBH (Group-A) and FGH (Group-B). Children were called for follow up after 1 week and at 6 months to assess for recurrence. Results Total 260 patients with inguinal hernia were enrolled (NCT: 03392636). The mean age of boys in Group-A was 5.2±3.0 years and in Group-B was 5.9±3.1 years. Mean operating time in Group-A (26.65±3.22 minutes) was longer than Group-B (15.92±4.22 minutes), and scrotal oedema was noted in 38 (29.2%) cases in Group-A, while 7 (5.4%) cases in Group-B. Testicular atrophy was noted in one patient of Group-B. Recurrence occurred in 1(0.8%) patient in Group-A, and in 8(6.2%) patients in Group-B (p-value 0.018). Conclusion Mitchell-Banks' herniotomy has lower recurrence rate than Ferguson and Gross Herniotomy in boys older than two years.
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Affiliation(s)
- Hafiz Mahmood Ahmad
- Dr. Hafiz Mahmood Ahmad, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Fatima Naumeri
- Dr. Fatima Naumeri, MCPS, FCPS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Usama Saud
- Dr. Usama Saud, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Ghazala Butt
- Dr. Ghazala Butt, MD, PhD. Department of Dermatology, King Edward Medical University/Mayo Hospital Lahore, Pakistan
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Lee MJ, Kim JK, Pokarowski M, Shiff M, Mitton P, Popescu A, Chung CT, Langer JC, Pierro A, Milner J, Lorenzo AJ, Koyle MA. Clinical and Economic Value of Routine Pathological Examination of Hernia Sacs and Scheduled Clinic Follow-Ups After Inguinal Hernia and Hydrocele Repair in a Canadian Tertiary Care Children's Hospital. J Pediatr Surg 2020; 55:1463-1469. [PMID: 31679775 DOI: 10.1016/j.jpedsurg.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The clinical and economical value of routine submission of hernia sacs for pathological examination and scheduled clinic follow-ups after inguinal hernia and hydrocele repair has been questioned. Herein, we assessed the institutional variability in these routine practices. METHODS We retrospectively reviewed patients who underwent unilateral or bilateral inguinal hernia and/or hydrocele repair, open or laparoscopically, at our institution from 2015 to 2018. RESULTS 1181 patients were included (1074 inguinal hernias and 157 hydroceles). Of 531 specimens obtained from 446 (38%) patients, 515 (97%) were normal. 16 (3%) abnormal pathological findings included 7 with mesothelial hyperplasia, 5 with nonfunctional genital ductal remnants, 3 with ectopic adrenal cortical tissues, and 1 epidydimal structure which was not recognized at the time of surgery. 418 (35%) patients had scheduled clinic follow-ups 65 (IQR 46-94) days postoperatively. 44 (4%) patients with unexpected postoperative Emergency Department visits within 30 days of surgery were identified. Only one patient required inpatient treatment, and the rest did not require intervention or admission. The total direct cost of analyzing specimens during the study period was $30,798 CAD ($10,266/year). The average cost to detect a potentially significant finding was $1924.88/specimen and $2053.20/patient. CONCLUSIONS Routine pathological examination of hernia sacs and scheduled clinic follow-ups were associated with significant costs and predominantly nonsignificant findings. They should therefore be reserved for patients with a high clinical suspicion of injuries/abnormalities or risk factors for potential complications. LEVEL OF EVIDENCE This is a level III evidence study.
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Affiliation(s)
- Min Joon Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mitchell Shiff
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Patricia Mitton
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Andreea Popescu
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Catherine T Chung
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joseph Milner
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
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Igwe AO, Talabi AO, Adisa AO, Adumah CC, Ogundele IO, Sowande OA, Adejuyigbe O. Comparative Study of Laparoscopic and Open Inguinal Herniotomy in Children in Ile Ife, Nigeria: A Prospective Randomized Trial. J Laparoendosc Adv Surg Tech A 2019; 29:1609-1615. [DOI: 10.1089/lap.2019.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Arua Obasi Igwe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ademola O. Talabi
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Adewale O. Adisa
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Collins C. Adumah
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ibukun O. Ogundele
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Oludayo A. Sowande
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Olusanya Adejuyigbe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
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