Laparoscopic suture-less herniotomy using tissue-sealing device for paediatric hydrocele

Comparison of the results of open repair and laparoscopic repair with the PIRS method in the treatment of hydrocele in children

PURPOSE

Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center.

METHODS

We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed.

RESULTS

The data of 113 patients (OR 58.4% (n = 66), LR 41.6% (n = 47)) were collected. In preoperative examination, 12.4% (n = 14) patients were diagnosed as communicating and 87.6% (n = 99) non-communicating hydrocele. Intraoperatively, 65.5% (n = 74) patients were communicating and 34.5% (n = 39) were non-communicating. Total recurrence rate was 7% (n = 8). The OR group experienced a recurrence rate of 10.6% (n = 7), while the LR group experienced 2.12% (n = 1).

CONCLUSION

Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.

Medium-Term Outcomes of the Godoy Burnia Repair: Durability of a Sutureless Laparoscopic Inguinal Hernia Repair in Girls

Background: Several methods to repair pediatric inguinal hernias utilizing a minimally invasive technique have been developed over the decades. These methods often involve passage of suture through the peritoneum at the level of the inguinal ring. We previously described the Godoy Burnia, a laparoscopic, sutureless, cautery-only inguinal hernia repair (IHR), and this follow-up study provides longer term data for this emerging surgical technique. Methods: After institutional review board approval, a single-centered retrospective review was performed of female pediatric patients with Godoy Burnia repair from 2014 to 2021. Demographics, operative details, and outcomes were reviewed. Technique: Through a single umbilical incision, a 3 mm port and camera and 3 mm Maryland dissector are placed into the abdomen. The Maryland dissector grasps the hernia sac, everts it, and brings it into the abdomen. Electrocautery is applied to allow scarring and closure of the inguinal ring. Results: Sixty-nine hernia repairs were performed on 44 patients with ages 5 days to 16 years (average 3.9 years) and weighing 2-70 kg (average 16 kg). Average follow-up was 52.8 months, and average operative times were 14/16 minutes for unilateral/bilateral repair, respectively. Twenty-two percent of hernias were found at time of another surgery and repaired. One recurrence (1.45%) in a 16-year-old patient, and 2 patients with other short-term complications. Conclusions: Godoy Burnia, a single-incision, sutureless, laparoscopic IHR in girls, is an acceptable alternative surgical technique with a low complication and recurrence rate. The longer follow-up in this study demonstrates the durability of the repair in most age groups, and decreased operative times suggest a favorable learning curve.

Laparoscopic vs. Open Repair Surgery for the Treatment of Communicating Hydrocele in Children: A Retrospective Study From a Single Center

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.