微型腹腔镜治疗小儿斜疝

目的 探讨微型腹腔镜治疗小儿斜疝的效果。方法 对78例应用微型腹腔镜治疗的斜疝患儿的临床资料进行回顾性分析。结果 28例患儿对侧鞘状突未闭，予同时行鞘状突高位结扎术，患和平均术后住院时间1－3d，较单侧手术患者无明显延长，切口无需缝合，无皮下血肿，所血性睾丸炎等并发症，随访0．5－1年，无复发；结论 微型腹腔镜可发现小儿隐匿性斜疝，并积极前瞻性治疗，消除了对侧斜疝发展至嵌顿绞窄的机会，减少另一次不可避免的手术创伤及医疗费用。     

微型腹腔镜下小儿腹股沟斜疝高位结扎术应用体会

目的 探讨微型腹腔镜下小儿腹股沟斜疝手术方法及疗效。方法 2002年10月～2004年4月我科使用微型腹腔镜及改进的疝带线针及针钩治疗小儿腹股沟斜疝38例。结果 38例手术均获得成功，手术时间10～50min，平均15min，术后6h进食，术后24～48h出院，无并发症，随访1个月～1年6个月，无复发。结论 微型腹腔镜下内环口结扎治疗小儿腹股沟斜疝较传统手术方法具有创伤小、美观、手术操作简便、手术时间短、并发症少、术后恢复快等优点：     

微型腹腔镜治疗小儿斜疝100例经验

本报道微型腹腔镜治疗小儿斜疝l00例手术方法及经验。手术方法对李氏方法加以改进：经脐和脐左3cm处分别插入腹腔镜和分离钳，经内环腹壁的投影处作l.5mm皮肤切口，用自制的带线雪橇针插入内环腹膜外，穿插两次完成内环高位缝扎。全部手术均获成功。术后当天患儿苏醒后即开始进食，第2天下床，第3天痊愈出院。3例术中拔出腹腔镜时网膜脱出，l例术后网膜经脐部切口脱出，1例双侧斜疝患儿术后4月单侧复发，余患儿无并发症出现。     

微型腹腔镜治疗小儿斜疝(30例报告)

目的：探讨微型腹腔镜治疗小儿斜疝的手术方法。方法：应用微型腹腔镜下缝合内环口治疗小儿斜疝30例，年龄2-11岁。结果：手术时间10-20min，术中和术后无并发症，术后随访半年至1年，无复发。结论：本法是一种创伤小，恢复快，安全有效的治疗小儿斜疝的手术方式。     

微型腹腔镜下治疗小儿腹股沟斜疝

我院2002年1月至2004年7月采用5mm腹腔镜治疗小儿腹股沟斜疝共45例,全部治愈,现将结果报道如下.     

微型腹腔镜治疗小儿腹股沟斜疝62例体会

目的:探讨微型腹腔镜治疗小儿腹股沟斜疝的可行性。方法:应用微型腹腔镜,采用自行设计的带线针和En-doc lose与操作钳配合,运用提插式缝合方法,高位荷包缝扎内环口周边腹膜,治疗小儿腹股沟斜疝62例。结果:62例手术均成功,手术时间10~15m in,住院2~3d。术后随诊1~28月无复发。结论:微型腹腔镜下高位荷包缝扎内环口治疗小儿腹股沟斜疝具有损伤小、恢复快、住院时间短、对侧再发率低的优点。     

腹腔镜手术治疗小儿腹股沟斜疝138例

目的探讨腹腔镜手术应用于小儿腹股沟斜疝的临床效果及其价值。方法回顾性分析2009年1月至2011年1月经腹腔镜手术治疗小儿腹股沟斜疝的138例患儿的临床资料,其中男131例,女7例,平均年龄（4．9±0．2）岁。单侧腹股沟斜疝114例,双侧腹股沟斜疝24例;术中发现对侧隐匿疝8例,对侧鞘状突未闭6例。全部患儿均采用腹腔镜手术治疗,均经过术后随访5—8个月,复发患儿再行腹腔镜手术。结果全部患儿均顺利完成手术,手术时间平均21min,住院时间3～5d。随访结果发现术后1个月2例出现复发,再次腹腔镜手术后治愈。结论经腹腔镜下手术治疗小儿膀股沟斜疝是一种专伞有效的手术方式,具有手术时间锕、创伤小、恢每懊的优点。     

腹腔镜手术治疗小儿腹股沟斜疝的价值

探讨腹腔镜手术治疗小儿腹股沟斜疝的手术方法及临床效果。选取2013年11月—2016年5月手术治疗的600例腹股沟斜疝患儿进行回顾性分析,其中300例采取腹腔镜手术治疗(腹腔镜组)、300例采取传统手术治疗(传统组),对比两组患儿的围手术期指标、手术效果。腹腔镜组的手术时间、手术出血量、术后下床活动时间、术后住院时间均显著低于传统组,差异有统计学意义(P<0.05);腹腔镜组的手术费用高于传统组,差异有统计学意义(P<0.05);两组患儿术前的各项肝功能指标、CRP水平差异均无统计学意义(P>0.05);术后24 h的ALT、AST、TP差异无统计学意义(P>0.05),腹腔镜组TBIL高于传统组(P<0.05),DBIL和CRP水平低于传统组(P<0.05)。腹腔镜手术治疗小儿腹股沟斜疝具有手术创伤小、恢复快、效果可靠的优点,但是手术费用较高,CO2气腹可能导致患儿血清TBIL、DBIL发生短暂性改变。     

经腹腔镜疝内口关闭术在小儿腹股沟斜疝中的应用

目的介绍经腹腔镜疝内口关闭术在小儿腹股沟斜疝中的应用。方法使用腹腔镜配合改进的微型腹腔镜抓钳和自制的钩针荷包缝合关闭内环口治疗小儿腹股沟斜疝25例。结果本手术方法的切口和创伤小，手术操作简单，手术时间短，恢复快，术后无需缝线、瘢痕小，无复发。结论本手术方法较之传统的小儿斜疝手术方法有较多的优点，值得临床推广。     

腹腔镜治疗小儿斜疝97例

目的探讨腹腔镜治疗小儿斜疝的临床价值. 方法单侧斜疝72例,双侧斜疝25例,采用自制缝合套管针行内环口腹膜下环周缝合,达到疝囊高位结扎. 结果 97例手术成功.平均手术时间:单侧10 min,双侧16 min.术后住院1 d,无并发症.70例随访2～60个月,平均31个月,无复发. 结论腹腔镜治疗小儿斜疝安全可行,创伤小,并发症少,恢复快,复发率低.     

Laparoscopic inguinal hernia repair in children

Childhood inguinal hernia is a result of a congenital patent processus vaginalis. In order to prevent strangulation of viscera trapped in the defect, surgery is necessary. Conventional operation for childhood inguinal hernia involves the use of a skin incision over the groin to dissect out the sac, taking care not to injure the adjacent important structures, namely the vas deferens and testicular vessels. The sac is then divided and the proximal end transfixed. With the advance in minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Modification of the technique by injecting normal saline extraperitoneally before the purse‐string closure of the neck of the processus vaginalis has made the procedure safer. An advantage of the laparoscopic procedure is that it allows detection and repair of the contralateral hernia. Randomised controlled trials are still required to verify the suggested advantages of better cosmesis outcome and more efficient pain control. Long‐term follow up in a large‐scale study is also desirable, to evaluate the cost‐effectiveness and possible complications of this mode of treatment.      

Special aspects of neonatal inguinal hernia and herniotomy

In a retrospective study, we examined 23 pre-term infants (18 boys, 5 girls) with a median weight of 1540 g (range 720–2770 g) and a median age of 32 weeks (range 25–36 weeks) gestation, who were subsequently operated on after a median of 65 days (range 20–121 days) for 33 inguinal hernias. The infants were evaluated with respect to concomitant diseases as well as peri- and postoperative complications. The following surgical procedure was used in all patients: a high suture ligation after excision of the hernia sac, followed by closure of the groin according to Grob in boys, and according to Bassini in girls. Co-morbidity was high in the pre-term infants, both pre- and perinatally. Despite this high co-morbidity and a high rate of emergency operations due to incarcerations, the postoperative complication rate was very low. However, the rate of testicular atrophy (10%) and recurrent inguinal hernia (9%) registered by us in the median follow-up of 575 days (range 105–1118 days) was much higher than that seen in older infants. Nevertheless, based on the low perioperative complication rate registered in the present study, we postulate that early surgery is tenable in pre-term infants despite the high co-morbidity and is even meaningful for the purpose of reducing the high rate of incarceration and testicular atrophy. The high recurrence rate in pre-term infants appears to be related to the numerous concomitant diseases in these patients, the resultant increase in intra-abdominal pressure and the small size of anatomical structures. Electronic Publication     

小儿复发性腹股沟疝的手术治疗

目的探讨小儿腹股沟疝术后复发原因及治疗。方法分析小儿腹股沟部的解剖特点,探讨复发性腹股沟疝的原因。应用疝囊高位结扎、内环缩小及腹横筋膜修补等术式治疗。结果 30例均于手术后7～10 d出院,经平均3年以上临床随访无复发,治疗效果满意。结论小儿腹股沟疝手术中,高位结扎、内环缩小、腹横筋膜修补是疗效可靠、防止复发的关键。     

Laparoscopic inguinal hernia repair-a prospective personal series of 542 children

Purpose

This series prospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair.

Methods

A total of 712 inguinal hernias were corrected laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). The internal inguinal ring was closed with a 4-0 nonabsorbable suture using 2-mm instruments. Patients were prospectively video-documented.

Results

There were no serious intraoperative complications. Operating time was comparable to open surgery. The contralateral inner ring was open on the left side in 16% of boys and 12% of girls, and on the right side in 18% of boys and 32% of girls. Direct hernias were found in 2.3%, femoral hernias in 1%, hernias en pantalon in 0.7%, and a combination of indirect and femoral hernia in 0.2%. Follow-up to date is 1-84 months (median 39 months). There were 4.1% hernia recurrences, 0.7% hydroceles and 0.2% testicular atrophies. Cosmesis is excellent.

Conclusions

Laparoscopic inguinal hernia repair can be a routine procedure with results comparable to those of open procedures. It is well suited for recurrences. The vas remains untouched. The visualization of structures is clear and leads to a defect-specific closure. The advantages of the laparoscopic approach include the following: its technical ease, it is an outpatient procedure, the cord structures remain untouched, the type of hernia is obvious, trocar placement is identical for any side or hernia type, clear visualization of the anatomy. Routine video documentation renders the diagnostic accuracy objective and absolute. Finally, recurrences are easier dealt with, be it from a previous open or from a laparoscopic approach. Although recurrences were slightly more frequent in the early stages, now they are closer to the rate with the open procedure.     

Laparoscopic approach to incarcerated inguinal hernia in children

Purpose

The purpose of this study was to describe the laparoscopic approach to incarcerated inguinal hernia in children.

Methods

After unsuccessful manual reduction, 29 patients (aged 3 weeks to 7 years; median, 10 weeks; 44 boys, 15 girls) with incarcerated inguinal hernia underwent immediate laparoscopy. The hernial content was reduced in a combined technique of external manual pressure and internal pulling by forceps. The bowel was inspected, and the hernia was repaired.

Results

In all patients, the procedure was successful. No conversion to the open approach was required. Immediate laparoscopic herniorrhaphy in the same session was added. No complications occurred.

Conclusions

Laparoscopy allowed for simultaneous reduction under direct visual control, inspection of the incarcerated organ, and definitive repair of the hernia. Technically, it appears easier than the conventional approach because of the internal inguinal ring being widened by intraabdominal carbon dioxide insufflation. The hospital stay is shorter.     

Two-trocar needlescopic approach to incarcerated inguinal hernia in children

Background

Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.

Methods

A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.

Results

In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.

Conclusions

The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.     

Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

Introduction: There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited. Methods: We reviewed our experience with 44 unsupplemented SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO₂) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants. Results: There was no significant change in systolic, diastolic, or mean blood pressures from pre‐SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO₂ across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia. Conclusions: The data suggest that SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.     

Looking past the lump: genetic aspects of inguinal hernia in children

Inguinal hernia is associated with a multitude of genetic syndromes. Disorders of the microfibril, elastin, collagen, and the glycosaminoglycan component of the extracellular matrix can result in an increase in the likelihood of inguinal hernia. In addition, inguinal hernia may be the presenting feature of disorders of sexual differentiation. Inguinal hernia of unknown etiology also occurs more commonly in several other groups of genetic diseases including chromosomal disorders, microdeletion disorders such as 22q11.2 microdeletion, and in single gene disorders. We review the genetics of connective tissue formation and focus on a series of genetic conditions that may present with or are characterized by a higher risk of inguinal hernia. A comprehensive review of the literature aims to provide a diagnostic framework to aid in the identification of patients with inguinal hernia as part of underlying genetic disease.     

腹股沟疝的个性化治疗

个性化治疗日渐成为普通外科的一种趋势,受到很多专家学者和临床医生的重视,腹股沟疝的治疗也是这样.随着新的观念、新的技术不断涌现,腹股沟疝治疗方法的选择成为困扰临床医生的新问题.本文就如何认识腹股沟疝的个性化治疗进行探讨.     

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。