Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Abstract

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.

Keywords

• inguinal hernia
• laparoscopic hernia repair
• children
• percutaneous internal ring suturing
• recurrence
• complication

Perkütan İnternal Ring Süturizasyonu Tekniği ile Daha İnce İğne ve Sütur Kullanılarak, Laparoskopik Pediatrik İnguinal Herni Onarımı; Tek Cerrah, 5 Yıllık Deneyim

Abstract

Amaç: Çocuklarda indirektinguinalherni onarımında perkütaninternal ring süturizasyonu (PİRS) minimal invaziv, kolay uygulanan ve güvenli bir laparoskopik cerrahi tedavi yöntemidir. Bu çalışmada indirektinguinalherni, kominikanhidrosel ve inkarsereinguinalherni tanılarıyla daha ince iğne ve sütur kullanılarak modifiye edilmiş PİRS tekniği ile opere edilen hastaların cerrahi sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada 2017-2023 yılları arasında, 3-12 yaş aralığında, PİRS tekniği ile opere edilen hastaların dosyaları retrospektif yöntemle taranmıştır. Hastaların yaşı, cinsiyeti, kilosu, inguinalherni/kominikanhidrosel/inkarsereherni tanı ve taraf bulgusu, hastalık öyküsü, cerrahi bulgusu, cerrahi süresi, komplikasyon ve rekürrens bilgisi çalışmaya dahil edilmiştir.Bulgular: 100 hastaya 129 PİRS prosedürü uygulanmıştır. Preoperatif değerlendirmede 63 hastada (%63) sağ taraf bulgusu saptanmıştır (1 kominikanhidrosel, 1 rekürreninguinalherni). 32 hastada (%32) sol taraf bulgusu saptanmıştır (1 kominikan hidrosel,1 rekürreninguinalherni). 5 hastada bilateral taraf bulgusu mevcuttur (1 inkarsereherni). 24 hastanın (%29) asemptomatikkontralateralhernisi saptanmıştır. Bu hastaların 11’i (%45) sağ tarafta, 13’ü sol taraftaydı (%55). Tek taraflı PİRS onarımı ortalama cerrahi süresi 13.5 dakika, bilateral PİRS onarımı ise 24.13 dakika sürmüştür. Tüm hastaların ortalama takip süresi 9 aydır. Hastaların 9’unda komplikasyon gözlenmiştir (%9). 3 hastada rekürrens saptanmıştır (%3). Sonuç: İndirektinguinalherni tedavisinde cerrahi sonuçlar değerlendirildiğinde PİRS yöntemi, açık herni onarımına bir alternatif olarak kolay uygulanan, güvenli ve minimal invaziv bir tedavidir.

Keywords

• Çocuk
• Komplikasyon
• İnguinal herni
• Laparoskopik
• Perkütan
• Rekürrens

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