小儿单侧腹股沟疝中腹腔镜探查预防对侧异时性疝分析

目的在小儿单侧腹股沟疝术中,用腹腔镜探查有无对侧鞘状突未闭(CPPV),行未闭鞘状突结扎术,研究其对预防对侧异时性疝(MCH)的作用,探讨腹腔镜探查的时机。方法回顾性分析铜陵市人民医院胃肠外科单侧腹股沟疝手术患儿,依据时间分为两组:2010年1月至2012年12月252例行开放疝囊结扎术(开放组),以及2013年1月至2015年3月184例行腹腔镜下经皮腹膜外疝囊高位结扎术,术中行对侧腹股沟区探查,如诊断存在CPPV,遂行结扎术(LPEC组),观察两组术后有无并发症、复发疝及MCH,并分析对侧新发疝的影响因素。结果开放组和LPEC组术后并发症发生率分别为:4.4%(11例)和1.6%(3例),术后疝复发率分别为:2.8%(7例)和0.5%(1例),差异无统计学意义(P0.05);术后随访时间平均为42个月和个22个月,MCH总发病率分别为5.2%(13例)和0.5%(1例),差异有统计学意义(P0.05);而术后24个月内MCH发病率分别为:3.6%(9/252)和0%(0/184)。其中LPEC组术中共发现CPPV 67例(36.4%),并都行结扎术。在0.6~2.0岁组CPPV发病率为56.1%(23/41),之后随年龄的增加CPPV发病率逐渐下降,至10~12岁组CPPV发病率为14.3%。开放组中MCH总发病率在早产儿为60%(9/15)而足月儿为1.7%(4/237),其差异有统计学意义(P0.05)。LPEC组中MCH总发病率在早产儿为0%(0/12)而足月儿为0.6%(1/172),其差异无统计学意义(P0.05)。结论所有患儿应常规行腹腔镜下探查CPPV,并行预防性结扎,可明显降低MCH的发病率,尤其对于4岁以内的右侧腹股沟疝的男性早产儿。     

腹腔镜下小儿腹股沟隐匿性疝的临床特点分析

目的:分析小儿单侧腹股沟斜疝合并对侧隐匿性疝的临床特点。方法:回顾分析2007年12月至2015年5月为4 232例患儿行腹腔镜疝囊高位结扎术的临床资料。结果:4 232例患儿中男3 776例,女456例,3 919例行单侧腹股沟斜疝手术,1 868例(47.7%)合并对侧隐匿性疝,其中左侧斜疝合并对侧隐匿性疝的比例为50.7%,右侧斜疝合并对侧隐匿性疝的比例为45.9%,差异有统计学意义(χ~2=8.4951,P=0.0036)。结论:对侧隐匿性疝发生率与性别、年龄无关。儿童单侧腹股沟斜疝合并对侧隐匿性疝比例较高,且不随年龄增长而降低。腹腔镜手术可同时探查双侧腹股沟,利于预防性处理对侧隐匿性疝,具有一定的临床优势。     

腹腔镜治疗成年人隐匿性腹股沟疝的临床研究

目的:分析腹腔镜一侧疝修补术患者对侧隐匿性腹股沟疝的存在概率及其危险因素评估,以判断需行双侧腹股沟区探查的患者范围。方法:回顾分析2014年至2015年因腹股沟疝就诊且行腹腔镜疝修补术的174例患者的临床资料,其中160例行单侧疝修补术的同时探查对侧腹股沟区,术后随访24~36个月,记录隐匿性疝、异时性对侧疝及手术并发症发生率。结果:完成双侧腹股沟区探查的患者中15例合并隐匿性对侧腹股沟疝,1例失访,余者中位随访29个月,6例(6/144)术中确认"健康"的对侧出现了腹股沟疝。术后发生血清肿2例、复发1例、网片移位1例、慢性疼痛5例,1例中转开放手术,未发生手术部位感染、肠管损伤、输精管与血管损伤。结论:对于高龄、男性、左侧、疝环缺损较大者,出现隐匿性对侧腹股沟疝的概率较高,建议术中行双侧腹股沟区探查,并根据患者具体情况决定是否行预防性对侧疝修补术。双侧预防性修补是安全的。     

小儿单侧斜疝对侧探查846例的评价

目的 探讨小儿单侧腹股沟斜疝行对侧探查的可行性指征,对降低对侧隐性疝的漏诊率提供方法。方法 分析2009年1月至2014年12月期间846例单侧腹股沟斜疝临床资料,根据家属意愿选择不同探查方式,分为开放探查组(76例)与腹腔镜组(770例),比较分析其对侧探查结果,采用SPSS 13.0进行统计学分析,术中对侧隐性疝阳性率、围手术期并发症比较采用χ2检验,P<0.05差异有统计学意义。结果 开放探查组76例患儿术前均被发现对侧腹股沟外环口宽松,能容纳成人一右手指以上(直径≥1.2 cm),经手术探查发现对侧隐性疝65例,发生率高达85.5%;腹腔镜组770例中有271例被发现对侧存在隐性疝,发生率为35.2%,差异有显著统计学意义(χ2=71.1,P<0.005)。开放探查组术中3例发生了并发症(3.9%),腹腔镜组有5例发生了并发症(0.6%),两组围手术期并发症发生率比较,差异有统计学意义(χ2=8.03,P<0.01)。结论 腹腔镜是诊断和治疗小儿对侧隐匿性腹股沟斜疝的最佳方法。对于无腹腔镜条件者,以外环口扩大作为手术探查的指征,特别是对侧外环口能容纳成人一右手食指尖以上(直径≥1.2 cm)的患儿,其探查意义更高。     

两孔法腹腔镜小儿疝囊高位结扎术与传统手术的临床比较

目的:对比两孔法腹腔镜小儿疝囊高位结扎术与传统手术治疗小儿腹股沟斜疝的优缺点。方法:随机将90例腹股沟斜疝患儿分为观察组和对照组。观察组45例行两孔法腹腔镜疝囊高位结扎术,对照组45例用传统术式。比较切口大小、手术时间、术中出血、住院时间、疼痛程度、并发症发生率等指标。结果:观察组切口大小、手术时间、术中出血、住院天数、疼痛程度、并发症发生率明显优于对照组(P<0.01)。结论:治疗小儿腹股沟斜疝,两孔法腹腔镜小儿疝囊高位结扎术操作简单,具有患儿创伤小、康复快等优点,是较理想的术式。     

经脐单孔腹腔镜疝囊高位结扎术的治疗效果

目的:探讨经脐单孔腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的临床效果及对术后并发症、复发率的影响。方法:将2010年6月至2015年6月行疝囊高位结扎的658例单侧腹股沟斜疝患儿分为腔镜组(n=476)与传统组(n=182),对比两组手术效果、并发症发生情况及随访3年复发率、对侧异时性疝发生率。结果:腔镜组手术时间、切口大小、术中出血量、住院时间、术后阴囊血肿、睾丸萎缩及并发症总体发生率均优于传统组,差异有统计学意义(P<0.05)。术后随访3年,腔镜组无对侧异时性疝发生,传统组对侧异时性疝发生率为2.75%,差异有统计学意义(P<0.05);两组术后复发率分别为0.42%与1.65%,差异无统计学意义(P>0.05)。结论:经脐单孔腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝效果良好,具有明显的微创优势,可减少术后并发症的发生,促进患儿快速康复,并能有效防止对侧异时性疝的发生。     

社区医院全科医师对小儿腹股沟疝的检出率及术式探讨

目的探讨社区医院全科医师对小儿腹股沟疝的检出率及手术方式。 方法选择2015年2月至2017年1月就诊于太阳宫社区卫生服务中心77例患儿的临床资料,由全科医师行问诊及相关的体格检查得出初步诊断,进一步行超声检查后转诊至上级医院行腹腔镜腹股沟疝疝囊高位结扎术,根据术中诊断回顾性评估社区医院全科医师对小儿腹股沟疝的检出率及社区医院超声诊断准确率,随访术后复发等情况。 结果77例患儿中,全科医师对小儿腹股沟疝检出率为42.9%,超声诊断准确率为70.1%,并且超声诊断单侧腹股沟疝的54例患儿中,对侧隐匿疝的发生率为35.2%。患儿行腹腔镜腹股沟疝疝囊高位结扎术后均随访6个月,术后阴囊短期内稍水肿,无血肿,无1例复发。 结论社区医院全科医师对小儿腹股沟疝检出率低,有必要对全科医师行儿童疝和腹壁外科专业培训降低漏诊率。腹腔镜治疗小儿腹股沟疝手术安全可行且可以同时发现对侧病变,降低了漏诊率,避免了二次手术的风险。     

腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性疝的临床研究

目的探讨腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性腹股沟疝的临床疗效,减少单侧腹股沟疝术后对侧假性复发的发生率。方法回顾性分析南昌大学第二附属医院胃肠外科2017年1月至2019年7月收治的单侧腹股沟疝行手术治疗的2155例病人,其中1105例病人行开放性疝修补术,927例病人行腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal hernia repair,TAPP),123例病人行腹腔镜完全腹膜外疝修补术(totally extraperitoneal hernia repair,TEP)。术后随访12~30个月,同时观察记录病人手术时间、住院时间、术后并发症以及疝复发率等情况。结果(1)1105例行开放疝修补术病人中,手术时间为(60.8±12.3)min,住院时间为(4.6±1.5)d,101例病人在随访期间复发(同侧复发14例,对侧假性复发87例),对侧假性复发率为7.87%(87/1105),29例病人术后出现伤口感染,36例病人术后出现慢性疼痛;(2)927例行TAPP病人中,手术时间为(45.9±10.1)min,住院时间为(3.1±0.9)d,22例病人在随访期间复发(同侧复发12例,对侧假性复发10例),对侧假性复发率为1.08%(10/927),2例病人出现观察孔感染,16例病人术后出现血肿或血清肿,15例病人术后出现慢性疼痛;(3)123例行TEP病人中,手术时间为(50.8±15.6)min,住院时间为(3.5±1.2)d,5例病人在随访期间复发(圴为对侧假性复发),对侧假性复发率为4.06%(5/123),3例病人中转TAPP,2例病人术后出现血肿或血清肿,3例病人术后出现慢性疼痛。所有病人术中均未出现损伤肠管、输尿管、精索血管等情况。结论TAPP手术应作为单侧腹股沟疝手术治疗的首选术式,该术式有手术时间短、术后恢复快、并发症少等优点。同时,TAPP手术方式能够明显增加隐匿性腹股沟疝的检出率,减少单侧腹股沟疝病人术后对侧腹股沟疝假性复发的风险。另外,对于隐匿性疝建议立即给予预防性的修补,避免病人再次手术。     

“弹琵琶”手法在小儿男性腹股沟斜疝术中的应用

目的探讨在小儿男性腹股沟斜疝术中寻找疝囊的简便技巧。方法男性腹股沟斜疝择期手术患儿129例(144侧),应用"弹琵琶"手法寻找疝囊,行疝囊高位结扎术。结果全部病例均顺利找到疝囊,行高位结扎疝囊144侧;切口平均长度为1.0 cm,术中寻找疝囊时间平均2.5 min,平均手术时间12.7 mim;术后近期阴囊轻度水肿12例,未发生其他并发症;平均随访21月,2例单侧巨大型腹股沟斜疝患儿术后复发;5例术后出现对侧腹股沟斜疝。结论在小儿男性腹股沟斜疝择期手术中,应用"弹琵琶"手法寻找疝囊,行疝囊高位结扎术,可达到操作简便、微创、快速、安全的效果。     

改良双钩疝针法在腹腔镜下小儿疝囊高位结扎术中的临床应用分析

目的分析改良双钩疝针法在腹腔镜下小儿疝囊高位结扎术中的临床应用效果。方法选取2016年7月至2018年5月我院收治的210例腹股沟疝患儿为研究对象,根据手术方式的不同将其分为治疗组(110例)及对照组(100例)。2组患儿均行腹腔镜下疝囊高位结扎术,对照组给予改良单钩疝针法手术,治疗组给予改良双钩疝针法手术。比较2组手术临床指标,并统计2组术后并发症发生率及复发率。结果治疗组手术时间、术后排气时间、下床自主活动时间及住院时间显著短于对照组(P0.05),2组住院时间无显著差异(P0.05)。治疗组并发症发生率显著低于对照组(6.36%vs 16.00%,P0.05);治疗组复发率显著低于对照组(0.91%vs 8.00%,P0.05)。结论腹腔镜下疝囊高位结扎术中应用改良双钩疝针法可缩短腹股沟疝患儿手术时间,促进其恢复,并降低患儿并发症发生率及复发率,值得临床推广应用。     

Transinguinal laparoscopic exploration for identification of contralateral inguinal hernias in pediatric patients

BackgroundThe use of transinguinal laparoscopy for contralateral groin exploration during unilateral inguinal hernia repair has gained popularity. Controversy exists, however, regarding its use in older children. We report a large, single-surgeon series describing the safety and effectiveness of this procedure.MethodsA retrospective review was completed of all cases of open inguinal hernia repair from 1997 to 2009 performed by the senior author. Patients were explored laparoscopically through the ipsilateral hernia sac to assess the contralateral groin. Exclusion criteria were an inadequate sac or preoperatively diagnosed bilateral inguinal hernia.ResultsA total of 649 children underwent open inguinal hernia repair. A preoperative diagnosis of bilateral hernia was made in 18% (n = 117), and of the 532 unilateral cases, an inadequate sac was present in 15% (n = 79). Transinguinal laparoscopic exploration was performed on the remaining 453 children. A hernia or contralateral patent processus vaginalis (CPPV) was found in 38% of children (n = 173). In children older than 8 years, 32% demonstrated a hernia or CPPV on laparoscopic exploration. No complications occurred because of laparoscopy.ConclusionTransinguinal laparoscopic exploration is safe and effective and should be routinely performed in pediatric patients of all ages because of the high prevalence of contralateral hernia and CPPV.     

Is there an increased risk of complications with laparoscopy looking for a contralateral patent processus vaginalis?

Abstract Background: In young children with a unilateral congenital inguinal hernia, the relatively high incidence of an occult contralateral patent processus vaginalis (CPPV) has led to the practice of laparoscopic contralateral exploration. The effect on postoperative complications such as surgical site infection from performing the laparoscopy has not been previously reported. Patients and Methods: A retrospective review was conducted on all patients who underwent a unilateral inguinal hernia repair from January 1, 2000 to March 1, 2010. We compared those children who underwent laparoscopic evaluation of the contralateral inguinal ring with those who did not. Patient demographics and operative data outcomes were evaluated. Student's t test was used to compare continuous variables, and the chi-squared test with Yates's correction was used for discrete variables. Results: There were 1164 patients who underwent a unilateral inguinal hernia repair during the 10-year study period, and laparoscopy was used in 1010 patients. There were no intraoperative complications from the laparoscopy. In the group who underwent laparoscopy, the mean age was 4.0±3.6 years old, and 88% were male. At laparoscopic exploration, 315 (31%) patients were found to have a CPPV. There were 10 patients (1.0%) who developed a surgical site infection. Infection developed in the side used for laparoscopic exploration in 9 patients and in the contralateral side in 1 patient. All patients with surgical site infections were treated initially with oral antibiotics. Abscesses developed in 2 patients, requiring incision and drainage. No patient required hospital admission or reoperation. In the 154 patients who did not undergo laparoscopy, mean age was 4.3±4.4 years (P=.35), and 85.8% were male (P=.54). There was one wound infection identified in this control group (0.6%) (P=1.00). There was no difference in rate of recurrence (control group, 0%; exploration group, 0.6%; P=.72). Conclusions: There is minimal risk of infection or recurrence following unilateral inguinal hernia repair, and this risk is not increased with the use of contralateral exploration using laparoscopy.     

Laparoscopic diagnosis of contralateral patent processus vaginalis in children under 1 year of age with unilateral inguinal hernia: comparison with herniography.

PURPOSE: The effectiveness of laparoscopic diagnosis of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia was evaluated. METHODS: Ninety-three consecutive children under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral CPPV was diagnosed by laparoscopy via the inguinal hernia sac before ligation. The laparoscopy results of this technique were correlated with those of herniography or inguinal exploration. RESULTS: Laparoscopy was performed on 88 patients; sensitivity was 71% and specificity 89%. The only complication arising from the procedure was wound infection in two patients. CONCLUSION: This method is a simple, safe, and accurate procedure for selecting children for contralateral surgical exploration.     

Laparoscopic repair on asymptomatic contralateral patent processus vaginalis in children with unilateral inguinal hernia: A centre experience and review of the literature

Purpose: We investigate the prevalence of contralateral patent processus vaginalis (CPPV) in children presenting with symptomatic unilateral inguinal hernia under diagnostic laparoscopy and its implication on contralateral surgery. Methods: Over a 24‐month period, 79 children (66 boys, 13 girls) aged 1 month to 8 years with symptomatic unilateral inguinal hernia underwent laparoscopic hernia repair. Twenty‐nine patients (36.7%) were under 24 months of age and 45 (57.0%) presented with right inguinal hernia. The contralateral internal inguinal ring was evaluated for CPPV. Bilateral repairs were carried out if CPPV was present. Results: The overall prevalence of asymptomatic CPPV was 39.2% in children who presented with unilateral inguinal hernia. The prevalence of asymptomatic CPPV was 48.3% for children aged under 24 months old and 26.0% in children above 24 months old (P = 0.044). CPPV was present in 52.9% of left‐side hernia under laparoscopy and in 28.9% of right‐side hernia (P = 0.030). Conclusion: The prevalence of asymptomatic CPPV under laparoscopy is nearly twice the reported incidence of symptomatic contralateral hernia development after conventional unilateral herniotomy. Further studies on the natural history of CPPV are necessary to determine the indications for repair of asymptomatic CPPV.     

The parental perspective regarding the contralateral inguinal region in a child with a known unilateral inguinal hernia

Purpose

The management of the contralateral region in a child with a known inguinal hernia has been debated by surgeons for more than 50 years. However, the perspective of the child’s parents has not been sought, and this study was designed to evaluate parental views on this topic.

Methods

After IRB approval, all patients less than 10 years of age with a unilateral inguinal hernia seen by the senior surgeon were studied prospectively from November 2001 through February 2003. A study sheet was given to the parents about the nature of an inguinal hernia, the incidence of 20% to 40% of a contralateral patent processus vaginalis (CPPV), and the possible surgical options (perform repair of the unilateral inguinal hernia only, repair the unilateral inguinal hernia with contralateral exploration and repair if indicated, or unilateral inguinal hernia repair with laparoscopy through the ipsilateral hernia sac and repair of a CPPV if discovered). The parents of the last 113 patients requesting contralateral inspection were asked their motives (convenience or anesthesia concerns) regarding their decision.

Results

One hundred sixty-seven patients comprise the study group. Twelve parents chose unilateral repair alone, 13 chose bilateral incisions with contralateral repair if a CPPV was found, and 142 chose unilateral hernia repair with laparoscopic contralateral inspection followed by repair if needed. Regarding their motives, 90 of the last 113 parents requesting contralateral inspection indicated that convenience was the primary motive. Surprisingly, only 21 exhibited concerns about their child undergoing a second anesthesia.

Conclusions

When presented options regarding management of a unilateral inguinal hernia, parents preferred laparoscopic inspection and repair of the contralateral region, if needed, more for convenience than for concerns about a second procedure and anesthesia.     

腹腔镜经脐双孔治疗小儿腹股沟斜疝的疗效

目的观察采用经脐双孔法腹腔镜治疗小儿腹股沟斜疝的手术效果。 方法回顾分析2018年1~12月北京市通州区妇幼保健院154例经脐双孔法腹腔镜治疗小儿腹股沟斜疝临床资料，评估经脐双孔法腹腔镜治疗腹股沟斜疝临床疗效。 结果所有患儿顺利完成手术，其中单侧腹股沟斜疝71例（46.1%），双侧腹股沟斜疝6例（3.8%），术中发现对侧隐匿疝77例（50%），单侧腹股沟斜疝平均手术时间（32.7±10.1）min，双侧腹股沟斜疝平均手术时间（33.4±10.9）min。术后随访6个月，未发现复发、阴囊血肿、睾丸萎缩及脐疝等相关并发症。 结论经脐双孔法腹腔镜治疗小儿腹股沟斜疝疗效确切，术后瘢痕小，术后并发症低。     

Laparoscopic exploration for the clinically undetected hernia in infancy and childhood

BACKGROUND: Routine contralateral groin exploration in infants and children with a clinically detected inguinal hernia is the subject of much debate. The detection of a patent processus vaginalis by transinguinal laparoscopy has proven advantageous. However, controversy remains regarding the true incidence of a contralateral patent processus vaginalis as well as which of these will actually develop into a clinically apparent hernia. METHODS: From January 1997 through December 1999, 358 infants and children (aged 1 to 157 months, mean 32) were treated in the three University of Oklahoma teaching hospitals in Tulsa, Oklahoma, for inguinal hernia. The findings at laparoscopic exploration of the contralateral side were recorded to determine the incidence of contralateral patency as it relates to a child's age, gender, and side of the initial clinical diagnosis. RESULTS: The overall incidence of a patent processus vaginalis on contralateral examination was 33% (117 of 358). All patent processus vaginalis were repaired. Bilateral inguinal hernia was significantly more common in younger patients (present in 50% if less than 1 year, 45% if less than 2 years, 37% if less than 5 years, and 15% if greater than 5 years of age; P <0.05). In boys, the incidence was 49%, 45%, and 32% in those under 1 year of age, under 2 years of age, and in total, respectively. In girls, the incidence was 59%, 50%, and 37% in those under 1 year of age, under 2 years of age, and in total, respectively. The side of the clinically detected hernia did not influence the laparoscopic findings of a contralateral hernia with 30% (50 of 169) positive findings on left inguinal exploration versus 31% (28 of 90) positive findings on right inguinal exploration. CONCLUSIONS: The high incidence of a contralateral patent processus vaginalis warrants routine laparoscopic exploration in infants and children undergoing unilateral inguinal hernia repair, especially those less than 5 years of age. The use of transinguinal laparoscopic explorations avoids unnecessary open exploration in 66% of infants and children undergoing inguinal hernia repair.     

Selective laparoscopic probing for a contralateral patent processus vaginalis reduces the need for contralateral exploration in inconclusive cases

BACKGROUND/PURPOSE: Repair of an indirect inguinal hernia is the most common procedure performed by pediatric surgeons, yet the need for contralateral exploration remains controversial. This prospective study evaluated the use of laparoscopy combined with the selective use of probing to determine the presence or absence of a contralateral patent processus vaginalis (CPPV). METHODS: A consecutive series of 75 of the author's patients presenting with a unilateral inguinal hernia were studied. Laparoscopy was performed through the known hernia sac with CO2 insufflation utilizing a 4-mm 70 degrees telescope to inspect the contralateral inguinal region. A patent processus was diagnosed when an obvious opening through the internal ring was identified. In some patients this evaluation was found to be inconclusive because of the inability to determine accurately the length of the patent processus or to rule out a patent processus obscured by a veil of peritoneum. This group of patients was then evaluated selectively with a silver probe placed under direct vision through a 14-gauge intravenous catheter placed through the abdominal wall on the side in question to manipulate the peritoneum and directly measure the length of the potentially patent processus. A patent processus greater then 1.5 cm was considered positive. RESULTS: A total of 54 patients (72%) had a conclusive laparoscopic evaluation of the contralateral inguinal region with a CPPV clearly absent in 38 and an obvious CPPV present in 16. A total of 21 patients (28%) had inconclusive laparoscopy finding and were evaluated further with probing. The probing technique changed the determination of a CPPV in 15 patients (12 positive to negative and 3 negative to positive; P = .029, Fisher's Exact test). Probing resulted in a decrease in the overall rate of identification of a CPPV from 45% to 32%. CONCLUSION: In inconclusive cases, the addition of selective probing to the laparoscopic evaluation for a CPPV reduces the number of patent processus vaginalis found and the need for contralateral inguinal exploration.     

单侧复发性腹股沟疝腔镜下修补的临床分析

目的探讨单侧复发性腹股沟疝腔镜下修补术的临床体会。 方法回顾性分析2009年1月至2019年1月，福建医科大学附属第一医院收治的123例腔镜下修补单侧复发性腹股沟疝患者的临床资料。通过手术时间、有无中转手术、发生副损伤、术后第1天疼痛评分、术后住院时间、术后并发症发生情况，分析腔镜修补单侧复发性腹股沟疝的临床效果。 结果123例单侧复发性腹股沟疝患者，采用腹腔镜完全腹膜外疝修补术（TEP）患者54例，采用腹腔镜经腹腹膜前疝修补术（TAPP）患者59例，采用腹腔内修补术（IPOM）患者10例。平均手术时间（50.68±9.46）min，术后第1天视觉模拟疼痛评分（2.19±1.76）分，术后住院时间（2.25±1.40）d。术后累计并发症患者12例（9.76%），均治愈出院，随访时间内无复发。 结论腔镜修补手术（TEP、TAPP及IPOM）是治疗复发性腹股沟疝安全有效的方法，可以在有条件的单位开展。     

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country

Purpose

We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.

Methods

Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed.

Results

We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months.

Conclusions

Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.