A Review of the Incidence, Manifestation, Predisposing Factors, and Management of Recurrent Pediatric Inguinal Hernia
A Review of the Incidence, Manifestation, Predisposing Factors, and Management of Recurrent Pediatric Inguinal Hernia
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DOI：
10.1055/s-0037-1608675
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发表时间：
2017-12-01
影响因子：
1.8
通讯作者：
Koivusalo, Antti I.
中科院分区：
文献类型：
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作者：
Koivusalo, Antti I.
复发性小儿腹股沟疝相对罕见。在大型系列中，复发率从 0.3% 到 1.2% 不等。在为各种儿科患者提供外科手术服务的大学医院中，实际复发率可能为 3% 至 6%。复发通常在首次修复后 6 个月出现。目前的证据表明，开腹和腹腔镜修复的复发率相似。然而，腹腔镜修复仍然由少数熟练的儿科外科医生进行，而大多数儿科外科医生依赖开放式修复，尤其是因为假定复发风险较低。间接疝修补术后，大多数复发（97%）是间接复发，而在极少数情况下，复发是以前未诊断的直疝或股疝。芬兰赫尔辛基儿童医院2012年至2016年的复发率为2.8%，复发性疝气手术占总数的3.3%。 1991年至2017年，共有130例复发性疝气手术，采用开放腹股沟入路（n=75，58%）、腹腔镜手术（n=49，38%）和开腹手术（n=4，4%）。一名青少年患者接受了 Lichtenstein Prolene 网修复术。复发性腹股沟疝气可以通过开放或腹腔镜方法修复。在腹腔镜检查中，可以明确复发疝的性质，并通过腹腔镜或开放技术立即进行修复。在专家手中，使用肌弓、脐外侧韧带、髂耻束和囊分割的新腹腔镜技术可能是简单荷包闭合的替代方法。
Recurrent pediatric inguinal hernia is relatively rare. In a large series, the recurrence rates vary from 0.3 to 1.2%. In a university hospital with surgical service for a wide spectrum of sick pediatric patients, the real recurrence rate may be 3 to 6%. Recurrence manifests typically 6 months after first repair. Current evidence indicates that recurrence rates in open and laparoscopic repair are similar. Laparoscopic repairs are, however, still performed by a minority of skilled pediatric surgeons, whereas the majority of pediatric surgeons rely on open repair not least because of the assumed lower risk of recurrence. After repair of an indirect hernia, the majority of recurrences (97%) are indirect, whereas in rare cases the recurrence turns out to be a formerly undiagnosed direct or femoral hernia. In Children's Hospital of Helsinki, Finland, recurrence rate from 2012 to 2016 was 2.8% and operations for recurrent hernias comprised 3.3% of the total. From 1991 to 2017, a total of 130 operations for recurrent hernias were performed with open inguinal approach ( n =75, 58%), laparoscopy ( n =49, 38%), and laparotomy ( n =4, 4%). One teenage patient underwent a Lichtenstein Prolene net repair. A recurrent inguinal hernia can be repaired either with an open or laparoscopic approach. In laparoscopy, the nature of the recurrent hernia can be clarified and an immediate repair performed either by laparoscopic or open technique. In expert hands new laparoscopic techniques using muscular arch, lateral umbilical ligament, iliopubic tract, and division of the sac may be an alternative to a simple purse-string closure.