High recurrence rate of children's inguinal hernia after percutaneous internal ring suturing: a single-center study

AIM

To evaluate and compare the differences in recurrence rates of post inguinal hernia repair in children using Laparoscopic Intracorporeal Closure of the Processus Vaginalis (LICPV) and Percutaneous Internal Ring Closure (PIRS) operating techniques and compare them to published data.

METHODS

A retrospective data analysis of children who underwent LICPV or PIRS techniques between 2005 and 2018 in the tertiary paediatric surgery department of university hospital was done. We analyzed demographic data, operating time, the influence of surgeon, recurrence rate, and the time until recurrence within an observed period of time post-operatively.

RESULTS

A total of 240 patients underwent laparoscopic inguinal hernia repair procedures between 2005 and 2018. Of them 138 (57.5%) were male and 102 (42.5%) were female, with mean age of 6.48 (SD ± 4.7). LICPV method accounted for 170 (70.8%) inguinal hernia repairs, whilst 70 (29.2%) underwent the PIRS procedure. The overall recurrence rate was 8.3%; it was significantly higher in the PIRS group (18.6% versus 4.11%, p < 0.05). Males presented higher recurrence rates over females across both procedures. The mean time taken for any recurrence to happen was shorter in patients who underwent the PIRS method as opposed to LICPV techniques, 3.3 and 6.5 months, respectively (p > 0.05).

CONCLUSION

In our hands, a significantly higher recurrence rate exists for children undergoing the PIRS method over LICPV techniques when treating inguinal hernias.

Single-Incision Percutaneous Closure of Pediatric Inguinal Hernia: A New Modification for Intracorporeal Suture Knotting

Background

Single-incision percutaneous closure (SIPC) of pediatric inguinal hernia under laparoscopic guidance is a well-developed feasible technique; however, suture knotting remains a major challenge during this technique. Most laparoscopic surgeons prefer extracorporeal subcutaneous suture knotting, which may be associated with consequent formation of stitch sinus and increased recurrence rate. On the other hand, intracorporeal suture knotting necessitates the availability of special devices or homemade instruments with a long learning curve. Therefore, the present study innovates new and simple modification allowing intracorporeal suture knotting during SIPC of pediatric inguinal hernia that does not require any special operating devices or homemade instruments. Patients and Methods. Four-hundred children suffering from inguinal hernia of congenital type, submitted to SIPC using Epidural needle (EN), under laparoscopic guidance with intracorporeal suture knotting.

Results

Children ages were 6 months to 10 years (the range). There were 300 boys and 100 girls, and two-hundred children suffered from left side hernia, 150 with right-side hernia, and 50 children with both left- and right-side hernia. 10 ± 2.2 minutes was the recorded operation time in one side hernia repair, while 14 ± 4.3 minutes was recorded for both side repair. Postoperative results reported recurrent hernia in one child and postoperative hydrocele in 3 children which resolved spontaneously after 3 weeks of follow-up.

Conclusion

Intracorporeal suture knotting during SIPC of pediatric inguinal hernia allows for the transformation of a formally extraperitoneal procedure to an intraperitoneal procedure. This new modification for intracorporeal suture knotting does not require any special operating devices or homemade instruments. It seems to be an attractive way during SIPC of pediatric inguinal hernia when intracorporeal suture knotting is considered.