Laparoscopic needle-assisted inguinal hernia repair in 495 children
Laparoscopic needle-assisted inguinal hernia repair in 495 children
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DOI：
10.1007/s00464-014-3739-8
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发表时间：
2015-04-01
影响因子：
3.1
通讯作者：
Hebra, Andre
中科院分区：
文献类型：
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作者：
McClain, Lauren;Streck, Christian;Hebra, Andre
小儿腹股沟疝的微创修补术一直是小儿外科医生争论的话题。我们采用腹腔镜技术行腹股沟疝修补术的结果与标准开放技术相当。我们描述我们的技术和经验，腹腔镜针辅助腹股沟疝修补术（LNAR）。我们报告了2009年至2013年由3名外科医生进行的502例（710例疝）。我们回顾了前瞻性收集的2009年1月至2013年3月接受LNAR的所有患者的结局数据库。对495例13岁以下患者中的502例710例腹股沟疝进行了分析和回顾。疝修补术采用单孔针辅助技术完成。在确定迷走突未闭后，使用22 G-Touhy针将内环在腹膜外平面环绕，用于放置荷包缝合，在腹膜外打结，并埋入皮下。该技术对所有病例都是标准化的。495例患者（408例男孩和87例女孩）接受了710例腹股沟疝的腹腔镜修补术，年龄范围为11天至12.8岁（平均29.2个月;中位数15.5个月）。294例患者进行了单侧修复（199例R和95例L），208例患者进行了双侧修复。单侧平均手术时间为20.5分钟，双侧为26.4分钟。确定了21例轻微并发症（9例浅表伤口感染，8例缝线肉芽肿和4例复发性鞘膜积液）和4例复发。手术后平均时间为30个月（3-54个月）。平均随访10.7个月（0.3-38.4个月）。术后数据显示，我们的技术是安全的，轻微并发症发生率为4%。疝复发率为0.56%（4/710）。这种复发率是相当的，在许多情况下低于开放技术。此外，腹腔镜客观地识别无症状或隐匿性对侧缺损，使用较小的切口，并消除脊髓结构的夹层，从而降低脊髓损伤的风险。
Minimally invasive surgery for inguinal hernia repair in children has been a controversial topic for pediatric surgeons. Our method for inguinal hernia repair using laparoscopic techniques has comparable outcomes to the standard open technique. We describe our technique and experience with the laparoscopic needle-assisted repair of inguinal hernia (LNAR). We report 502 cases (710 hernias) from 2009 to 2013 by 3 surgeons. We reviewed our prospectively collected outcomes database of all patients receiving LNAR from 1/2009 to 3/2013. 502 cases in 495 patients < 13 years old with 710 inguinal hernias were identified for analysis and review. Hernia repair is accomplished with a single-port needle-assisted technique. After identification of a patent processus vaginalis, the internal ring is encircled in an extraperitoneal plane using a 22G-Touhy needle for placement of a purse-string suture, tied extracorporally, and buried beneath the skin. The technique was standardized for all cases. 710 inguinal hernias were laparoscopically repaired in 495 patients (408 boys and 87 girls) age range 11 days to 12.8 years (mean 29.2 months; median 15.5 months). 294 patients had unilateral repair (199R and 95L) and 208 had bilateral repair. Mean operating time for unilateral was 20.5 min, and bilateral was 26.4 min. 21 minor complications were identified (9 superficial wound infections, 8 suture granulomas, and 4 recurrent hydroceles) and 4 recurrences. Mean time since surgery is 30 months (3-54 months). Mean follow-up was 10.7 months (0.3-38.4 months). Post-operative data show our technique is safe with a 4 % rate of minor complication. Recurrence rate was 0.56 % for the total number of hernias (4/710). This recurrence rate is comparable and in many cases less than open technique. Furthermore, laparoscopy objectively identifies asymptomatic or occult contralateral defect, uses a smaller incision, and eliminates dissection of the cord structures potentially reducing the risk of cord injury.