腹腔镜内环口缝扎术治疗小儿腹股沟斜疝

目的:探讨腹腔镜内环口缝扎术治疗小儿腹股沟斜疝的临床疗效和安全性。方法:回顾分析2004年7月至2010年4月为1586例小儿腹股沟斜疝患者行腹腔镜内环口缝扎术的临床资料。结果:1586例均顺利完成手术,手术时间8~20m in,平均14min,术中出血少于1ml,治愈率100%,腹部切口甲级愈合率100%。术后主要并发症包括复发5例,经再次手术治愈,切口大网膜疝出4例,阴囊水肿、血肿23例。无一例发生腹腔内脏器损伤、切口感染、肠粘连、睾丸萎缩等并发症。结论:腹腔镜内环口缝扎术治疗小儿腹股沟斜疝具有患者创伤小、操作简单、安全、美观、有效、并发症少、康复快、出血少、能治愈等优点,适于任何类型和任何年龄的小儿腹股沟斜疝。     

腹腔镜内环口缝扎术治疗小儿腹股沟斜疝的疗效

目的探讨腹腔镜内环口缝扎术治疗小儿腹股沟斜疝的疗效。方法选取2015年1月至2019年6月小儿腹股沟斜疝600例,依据手术方法分为A组(200例)和B组(400例),A组行传统疝囊高位结扎术治疗,B组行腹腔镜内环口缝扎术治疗。结果 B组的术中出血量、切口长度、下床时间、FLACC疼痛量表评分、发热人数、并发症发生率低于A组,B组的手术时间高于A组,差异有统计学意义(P0.05)。B组满意度高于A组,差异有统计学意义(P0.05)。结论腹腔镜内环口缝扎术可减少腹股沟斜疝患儿手术创伤及并发症,可促进患儿术后康复。     

单孔腹腔镜疝囊高位缝扎术治疗小儿腹股沟疝的应用体会

目的:探讨单孔腹腔镜疝囊高位缝扎术治疗小儿腹股沟疝的有效性.方法:回顾分析为20例腹股沟斜疝患儿行单孔腹腔镜疝囊高位缝扎术的临床资料.结果:本组20例均成功完成单孔腹腔镜手术,手术时间平均15min,术后平均住院2.5d,术后随访3～12个月,均无复发、睾丸回缩等并发症发生.结论:单孔腹腔镜疝囊高位缝扎术治疗小儿腹股沟...     

青少年腹股沟疝术后复发手术治疗9例临床分析

目的 分析青少年腹股沟疝术后复发的手术方式及效果。方法 回顾性分析佛山市第一人民医院2006年1月至2018年12月收治的9例青少年（13～18岁）腹股沟疝行手术治疗后复发病人的资料。主要收集病人前次手术方式、再次手术方式、疝环口大小、术后主要并发症及复发率。结果 170 例行腹股沟疝手术治疗的青少年病人中,有9例青少年复发性腹股沟斜疝（前次手术方式均为内环口高位结扎术）病例,其中2例行开放手术,7例行腹腔镜手术。9例病人中,3例为多次复发,6例为首次复发。术中见疝环口大小0.3～3.0 cm。手术方式,4例行腹腔镜内环口缝扎术,疝环口大小0.3～2.0 cm;5例行腹腔镜腹股沟疝补片修补术（3例为多次复发病人）,疝环口大小1.5～3.0 cm。随访6个月至10年,无伤口或补片感染,其中3例病人术后近期出现腹股沟区隐痛不适,行补片修补2例,行内环口高位结扎1例;1例出现血清肿,为补片修补;复发1例,为补片修补。结论 青少年复发性腹股沟疝再次手术方式应根据前次手术方式、复发次数及是否存在大的内环缺损或腹横筋膜缺损进行选择。初次复发、内环口缺损≤2 cm者,建议行腹腔镜内环口高位结扎。多次复发或内环口缺损大者,建议使用补片修补。     

改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液57例体会

目的探讨改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液的临床疗效。方法行改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液57例,单侧50例,双侧7例。均在单孔腹腔镜下行改良内环口荷包缝合高位结扎术。结果单侧手术时间平均15(12~18)min,双侧手术时间平均25(22~28)min,术中发现隐匿性疝5例,均在直视下一并进行高位结扎术,找到输精管及精索血管并避开。术中无明显出血及血肿,无阴囊积气及其他副损伤,术后平均住院2 d,切口以可吸收线缝合腹膜及皮下1针。术后平均随访12(6~24)个月,无复发,无切口及阴囊感染,无睾丸扭转、睾丸萎缩及发育异常等并发症发生。结论改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液具有安全有效、创伤小、无瘢痕、康复快、住院时间短、操作简便、无需特殊器械等优点,值得基层医院推广。     

改良一孔法微型腹腔镜治疗小儿腹股沟斜疝

目的探讨改良一孔法微型腹腔镜手术治疗小儿腹股沟斜疝的应用价值。方法采用特制穿刺针腹腔镜下一孔法巧妙手术步骤治疗小儿腹股沟斜疝40例,其中右侧22例,左侧10例,双侧8例。术前诊断单侧斜疝中有6例存在对侧隐性疝,均在腹腔镜下行内环口高位缝扎术。结果手术时间单侧疝平均12 min,双侧疝20 min。术后平均2 d出院。皮肤小戳口用皮肤胶粘合。10例有阴囊积气、腹膜外小血肿,1例复发,无其他严重并发症。结论改良一孔法微型腹腔镜下小儿腹股沟斜疝疝囊内环口高位缝扎术安全可靠、创伤小、美观且操作简便,术后恢复快,值得临床推广应用。     

改良单孔法微型腹腔镜治疗小儿腹股沟斜疝的临床应用

目的:探讨改良单孔法微型腹腔镜手术治疗腹股沟斜疝患儿的应用价值。方法:采用特制穿刺针施行单孔法腹腔镜手术治疗腹股沟斜疝患儿40例,其中右侧22例,左侧10例,双侧8例。术前诊断为单侧斜疝的患者中6例有对侧隐性疝,均在腹腔镜下行内环口高位缝扎术。结果:手术时间单侧疝平均12min,双侧疝20min。术后平均2d出院。腹壁小戳口用皮肤胶粘合。10例有阴囊积气、腹膜外小血肿,1例复发,无其他严重并发症发生。结论:改良单孔法微型腹腔镜小儿腹股沟斜疝疝囊内环口高位缝扎术安全可靠,患儿创伤小,美观且操作简便,术后康复快,值得临床推广应用。     

腹腔镜下单孔完全腹膜外结扎法与单切口腹内缝扎法治疗小儿腹股沟疝并发症的比较

目的比较单孔腹腔镜疝钩针法完全腹膜外内环结扎术与经脐单切口腹腔镜内环缝扎术治疗小儿腹股沟疝的并发症情况。方法回顾性分析2013年7月～2017年7月我院小儿外科341例小儿腹股沟斜疝患儿的临床资料,其中213例采用疝钩针法经脐单孔腹腔镜监视下完成腹膜外内环结扎术(腹膜外结扎组),128例在腹腔镜监视下采用经脐单切口多通道套管(Triport)内环缝扎术(腹内缝扎组),对比2组并发症发生情况。结果 341例患儿均顺利完成手术,无术中并发症发生。腹膜外结扎术组术后随访24～42个月,线结异物反应3例,鞘膜积液形成1例,对侧异时疝1例;腹内缝扎术组术后随访28～60个月,腹股沟局部血肿2例,鞘膜积液形成2例,疝复出1例;2组术后并发症发生率无统计学差异(χ~2=0.245,P=0.621)。所有男性患儿术后无一例出现医源性隐睾或睾丸萎缩。结论单孔腹腔镜疝钩针法完全腹膜外内环结扎术与经脐单切口腹腔镜内环缝扎术均安全可行,疗效可靠,2种方法并发症发生率无统计学差异。     

一孔法腹腔镜小儿腹股沟斜疝高位结扎术

目的探讨腹腔镜治疗小儿腹股沟斜疝新方法. 方法采用一孔法腹腔镜手术治疗小儿腹股沟斜疝48例,右侧31例,左侧13例,双侧4例,单侧斜疝中5例对侧存在隐性疝,均在腹腔镜下行内环口高位缝扎术. 结果手术时间7～14 min,平均9 min,术后平均住院24 h,皮肤无须缝线.随访3～15个月,平均9.5个月,未见复发. 结论一孔法腹腔镜下内环口高位缝扎术效果好,损伤轻,操作简便.     

腹腔镜小儿斜疝内环口缝扎术5例体会

20 0 2年 10月至 2 0 0 3年 3月我院共行腹腔镜小儿斜疝内环口缝扎术 5例 ,效果满意 ,现报道如下。1　资料与方法1 1　临床资料　腹股沟斜疝 5例均为男性 ,2～ 5岁 ,平均2 5岁。右侧腹股沟斜疝 2例 ,左侧 2例 ,双侧 1例。病程约2年 ,平均患病 1 5年。1 2　手术方法　采用基础麻醉、静脉麻醉或基础 +静脉麻醉。麻醉满意后常规消毒铺巾。取脐左缘 1cm切口生成气腹至 1 0 7～1 33kPa后 ,置入腹腔镜探查腹股沟区 ,于脐至耻骨中点右腹直肌旁建立 0 5cm操作孔 ,自腹壁外内环口处直针 4号丝线进入腹腔镜下行内环口缝扎。左右两侧缝扎的手术方法…     

Laparoscopic herniorrhaphy combined ligation of the hernial sac and suturation of the internal ring in children with indirect inguinal hernias

OBJECTIVE: To develop and evaluate the laparoscopic herniorrhaphy combined ligation of the hernial sac and suturation of the internal ring in children with indirect inguinal hernias. METHODS: Fifty-one indirect hernias in consecutive 41 children with indirect hernias underwent the herniorrhaphy from January 2003 to August 2005. The general information, operating time, postoperative duration in hospital, duration return to normal activity, operative faults, and complications were collected. RESULTS: No recurrence was found in the whole group of the patients during 1 month to 32 months follow-ups, 1 case complicated with postoperative hydrocele and 3 cases with inguinal pain. CONCLUSIONS: The laparoscopic procedure combined ligation of the hernial sac and suturation of the internal ring is a brand new, feasible, reliable, and efficient herniorrhaphy for pediatric inguinal indirect hernias.     

Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique

We describe our new technique for laparoscopic herniorrhaphy with subumbilical single-site access to treat inguinal hernias in children. First, we inserted a transparent 3-mm trocar and a 2-mm minitrocar at the umbilicus. We then inserted a 3-mm 45° camera through the 3-mm trocar and needle-grasping forceps through the 2-mm trocar. We closed the hernia defect by using a 19-gauge hooked injection needle with a nonabsorbable suture. We treated 11 consecutive female children with inguinal hernia using this operation. The mean operating time was 26.7 min (range 21–36 min) and the procedure was technically successful, without the need for additional trocars, in all 11 patients. There were no intraoperative complications and all the patients were discharged on the same day after the surgery. Single-site laparoscopic herniorrhaphy using needle instruments is feasible and seems to be safe. Further studies are required to determine whether this approach would benefit patient compared with standard laparoscopic herniorrhaphy.     

Laparoscopic herniorrhaphy in children

Background: We report our clinical experience with 403 inguinal hernias in 279 children. They were treated via a purely laparoscopic approach using 2-mm instruments, obviating the need for a groin incision. Methods: Laparoscopic herniorrhaphy was performed in children ages 4 days to 15 years. A 5-mm laparoscope was inserted through the umbilicus, and two 2-mm needle holders were inserted through the inferolateral abdominal wall. The open inner inguinal rings were closed by placing Z-sutures of monofilamentous nonabsorbable material. Results: The mean operating time was 14 min for unilateral hernias and 21 min for bilateral hernias. We found 3.9% direct hernias. Hydroceles occurred in 1.7% of patients, testicular atrophy was noted in one patient, and no hernia was found in 2.3%. In girls with inguinal hernias, a contralateral asymptomatic patent processus vaginalis (PPV) was found in 45.2%, regardless of whether the hernia was on the right or the left side. In boys with inguinal hernias, contralateral PPVs were found on the right side in 21.9% and on the left in 8%. There were no major complications. One conversion to an open procedure was necessary because of a dilated bowel. The mean follow-up period was 23 months. There were 2.7% hernia recurrences; this rate was slightly higher than that seen with the open technique. The incidence of direct inguinal hernias was higher than has been previously reported. Conclusions: Laparoscopic herniorrhaphy allows the surgeon to identify the type of defect and proceed with immediate treatment. This technique is safe, reproducible, and technically easy for experienced laparoscopists. Bilaterality is of no concern. The cosmetic results are excellent; and in patients with recurrence of a hernia, this procedure is preferable to the open technique.     

二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝556例

目的探讨二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的价值。方法建立气腹（压力8~10 mmHg）,脐上5 mm trocar作为观察孔放置30°腹腔镜,于脐水平线对侧腹直肌外缘3 mm trocar作为操作孔。疝内环口体表投影处做一约2 mm微小切口,经此切口刺入带7号丝线的GraNee针（卡钩针）,沿内环口的外半周用缝荷包法缝合腹膜,至内环口下方,打开卡钩针,取下缝合线,闭合卡钩针,取出,再次刺入,沿内环口内半周缝合,至与第1针汇合时再次打开卡钩针,将腹腔内留置的缝线置于卡钩针的针孔内,闭合卡钩针并退出,将缝线带出腹腔,体外打结。结果 553例在腹腔镜下完成疝囊高位结扎术,每侧手术时间2~5 min,平均3 min。3例因肠管胀气明显,手术操作空间狭小而中转开放手术。97例患儿对侧存在隐匿性疝,一并行疝囊高位结扎术。426例随访3~18个月,平均10个月,3例术后7~16 d复发,分别于术后3~6个月再次行腹腔镜下疝内环口高位结扎术,未再复发;1例术后3个月出现线结异物反应,给予换药处理,6个月后拆除缝线,斜疝未复发;无阴囊红肿及阴囊积气病例。结论二孔法腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝效果满意,值得推广应用。     

Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report

Background We designed a technique of pure minilaparoscopic hernia sac transaction and ligation to repair primary inguinal hernias in children and young adults. Methods Between September 2003 and December 2004, 83 patients with primary inguinal hernia were treated surgically with minilaparoscopic herniorrhaphy. The mean patient age was 6.8 years. Before the operation there were synchronous bilateral hernias in 2 (2.4%) patients, left inguinal hernias in 39 (47%) patients, and right inguinal hernias in 42 (50.6%) patients. The minilaparoscopic herniorrhaphy was carried out with the 3-mm laparoscopic and hand instrument system. Three 3.5-mm trocar ports were used for the telescope and 3-mm instruments. The peritoneum overlying the internal ring was circumferentially incised, then the peritoneal defect was closed with intracorporeal sutures. Results One hundred and fourteen minilaparoscopic herniorrhaphies were performed. The mean followup period was 12.9 months. The mean operation time was 52 min. There was only one recurrence (1.2%) that was detected nine months after primary repair. All patients were able to return to unrestricted activity immediately and were discharged within 24 h after the operation. There was no reported case of testicular atrophy to date. Conclusions Minilaparoscopic herniorrhaphy with hernia sac transaction is a safe and effective technique in children and young adults with indirect inguinal hernias.     

腹腔镜脐内侧襞瓣加强内环口疝修补术在儿童及青少年腹股沟斜疝中的应用

目的 探讨腹腔镜脐内侧襞瓣加强内环口疝修补术在治疗儿童和青少年腹股沟斜疝中的可行性及优越性.方法 从2001年10月至2005年1月,我院对110例(140侧)儿童实施了疝囊高位结扎术(A组).2005年1月至2011年2月,对于300例(405侧)患儿疝囊高位结扎术(B组)中,对有疝复发危险因素的47例患儿,加做脐内侧襞瓣覆盖加强内环口.结果 B组具有疝复发危险因素患儿47例,经腹腔镜脐内侧襞腹膜瓣加强内环口疝修补术均顺利完成.A组随访2～122个月,平均56个月,4例复发(2.8%).B组随访5～74个月,平均34个月,尚未见复发.二组患者随访期间均未见睾丸萎缩等并发症.结论 腹腔镜疝囊高位结扎合并脐内侧襞瓣覆盖内环口疝修补术是安全可靠的,对有选择的腹股沟斜疝患儿以及青少年腹股沟斜疝有进一步降低疝复发的作用.     

Single-Incision Laparoscopic Repair of Spigelian Hernia

Introduction:Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair.Methods:From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh.Results:There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m². An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months).Conclusions:Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.     

完全腹膜外腹腔镜腹股沟疝修补术的临床应用

目的：总结完全腹膜外腹腔镜腹股沟疝修补术（totally extraperitoneal prosthetic,TEP）的临床应用经验。方法：回顾分析2007年4月至2008年8月我院收治的58例腹股沟疝患者行TEP手术的临床资料。其中直疝16例、斜疝42例;单侧疝46例、双侧疝12例;复发疝16例。结果：手术均获成功,无中转手术。手术时间50～140min（平均单侧90min、双侧120min）。术后无须使用镇痛剂,住院时间3～10d,平均5d。术后出现阴囊血肿4例,血清肿21例。随访1～15个月,术后无复发。结论：TEP手术安全可靠,具有并发症少,术后疼痛轻、康复快、复发率低等优点,可同时对双侧疝进行处理,无需全身麻醉,具有明显的优越性,有广泛的应用前景,是值得临床推广的微创技术。     

Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children

Background: Laparoscopic herniorrhaphy in pediatric surgery is usually performed through three ports in the abdominal wall with intraperitoneal suturing. Our technique of percutaneous internal ring suturing (PIRS) requires only one umbilical port and needle puncture point. We describe the technique and evaluate the efficacy of percutaneous internal ring suturing for inguinal hernia repair in children. Materials and Methods: We performed percutaneous internal ring suturing on 106 children (ages 28 days-14.5 years) with 140 hernias. The procedures were performed under general endotracheal anesthesia. Pneumoperitoneum was established with an open technique. Under laparoscopic-guided vision an 18-gauge injection needle with a nonabsorbable thread inside the barrel of the needle was placed through the abdominal wall into the peritoneal cavity. By moving the injection needle, the thread passed under the peritoneum around the entrance into the hernia sac. The knot was tightened from outside and placed in the subcutaneous space. The contralateral open inguinal ring was closed in the same procedure. Results: The average operative time was 19 minutes for unilateral and 24 minutes for bilateral hernias. Follow-up ranged between 18 and 29 months. Cosmetic results are excellent with almost invisible scars. There were 3 cases of intraoperative complication: incidental puncture of the iliac vein that required no treatment. There were 4 cases of postoperative complications: one case of ileus adhesion with bowel strangulation, and hernia recurrence in 3 boys, one of whom was reoperated with percutaneous internal ring suturing. In 5 boys, transient hydroceles were observed that disappeared spontaneously after 3 to 5 months. Conclusion: The percutaneous internal ring suturing method seems to be a simple and effective minimally invasive procedure with excellent cosmetic results. The rate of complications is comparable to other laparoscopic techniques of inguinal hernia repair in children. According to our experience, percutaneous internal ring suturing should be considered as a treatment alternative.     

Hospital Costs Associated With Laparoscopic and Open Inguinal Herniorrhaphy

Purpose:

The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy.

Methods:

A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs.

Results:

Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827).

Conclusions:

In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.