Long-term outcomes of pediatric laparoscopic needled-assisted inguinal hernia repair: A 10-year experience

PurposeLaparoscopic inguinal hernia repair (LIHR) has gained wide acceptance over the past decade, although studies with longer term follow-up are lacking. We present one of the largest cohorts of children undergoing laparoscopic needle-assisted repair (LNAR) with long-term follow-up.MethodsA clinical quality database was maintained for children ≤ 14 years of age who underwent laparoscopic needle-assisted repair between 2009 and 2017 with review of follow-up through 2019. De-identified data was reviewed.Results1023 patients with 1457 LNAR were included during the 10-year period. Mean age at surgery was 2.56 years (2 days to14 years). The overall hernia recurrence rate was 0.75% (11/1457). A total of four postoperative hydroceles required intervention. Preterm infant repair done < 60w post conceptional age had a significantly lower recurrence rate (0.63%) than other patients (0.82%) (p < 0.01). 64.2% of patients had clinical follow-up over a period of 11 years with a mean follow-up of 5.97 years.ConclusionWe present a large cohort study of consecutive pediatric laparoscopic hernia repairs followed over an 11-year period. LNAR is safe and effective for term and preterm patients with similar complication rates to other techniques, including open repair. Additionally, our results suggest that preterm infants may have superior outcomes with this method.Level of EvidenceLevel III – Retrospective Comparative Study.     

腹腔镜腹股沟疝修补术的并发症分析

腹腔镜腹股沟疝修补术(laparoscopic inguinal hernia repair,LIHR)自1991年开展以来,在临床上应用愈来愈广泛,但随之也产生了一些并发症.本文结合文献报道和自身经验,对LIHR的各种并发症发生的原因、预防和处理作一探讨.     

腹腔镜腹股沟疝修补术的手术指征及并发症问题

腹股沟疝修补术经过一百多年的发展,已衍生出数十种修补方法,目前在临床上应用的每一种方法都是合理的,但适用的人群可能有所不同。腹腔镜腹股沟疝修补术（1aparoscopicinguinalherniarepair,LIHR）是上世纪90年代初发展起来的一种术式,如何在众多的术式中选择LIHR,首先必须充分了解LIHR的修补特性,合理的选择可获得最佳的临床效果和卫生经济学效益,同时也可避免不必要的过度手术;其次必须正确掌握LIHR的操作特点,可以把复发和并发症率降到最低。     

腹腔镜下微创治疗儿童腹股沟疝的临床体会

目的：探讨腹腔镜下微创治疗儿童腹股沟疝的可行性。方法回顾性分析2012年4月至2013年9月,六盘水市人民医院在全身麻醉腹腔镜下行儿童疝囊高位结扎治疗儿童腹股沟疝198例的临床资料。结果198例患者手术均顺利,手术时间10-20 min,平均15 min。术后均未用抗生素,术后6h内即可适量活动及进流质饮食。所有患者均达一期愈合,住院时间3-4d。术后随访6个月,均无复发、血肿、水肿等并发症;术后发生切口大网膜疝1例。结论儿童腹股沟疝行腹腔镜下疝囊高位结扎术,减少术后复发,并发症少,值得临床推广应用。     

Open and laparoscopic inguinal hernia repair in children: A regional experience

PurposeThe optimal approach for pediatric inguinal hernia repair continues to be debated. We conducted a regional retrospective study to assess rates of recurrence and metachronous hernias after open repair (OPEN) and laparoscopic repair (LAP)MethodsA retrospective cohort study was conducted at two children's hospitals that serve a region of approximately 4 million people. All patients < 14 years old undergoing OPEN or LAP by pediatric surgeons during a 5-year period (2011 – 2015) were analyzed after a minimum follow up of 4 years. Cox proportional regression was used to compare the effect of surgical approach on hernia recurrence and metachronous contralateral hernias.ResultsA total of 1,952 patients, 587 female (30%) and 1365 male (70%), had 2305 hernias repaired. Median post operative follow up time was 6.6 years (range 4–9 years). OPEN and LAP were performed for 1827 (79%) and 478 (21%) hernias, respectively. There were no significant differences in rate of prematurity, age at repair, or frequency of emergent repair. LAP was associated with a lower incidence of metachronous contralateral hernias compared to OPEN (1.4% vs 3.8%, p = 0.047), and a higher incidence of recurrence (9% vs 0.9%, p < 0.001). After adjusting for confounders, LAP had a higher rate of recurrence than OPEN (hazard ratio 10.4, 95% CI 6–18.1).The recurrence rate did not decrease over the study period (p = 0.731).ConclusionLaparoscopic inguinal hernia repair in children resulted in a modest decrease in the incidence of metachronous hernias, at the cost of a significant increase in recurrence.Type of StudyRetrospective Comparative Study.Level of evidenceLevel III.     

Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.     

15-year experience of using relaparoscopy in the diagnostics and treatment of complications after laparoscopic choledoholithotripsy

Results of relaparoscopy were analyzed in 42 patients with complications appearing after using 297 laparoscopic choledocholithotomies. Relaparotomies were classified according to the indications and terms from the main interventions. An analysis of complications after laparoscopic choledocholithotomy was made. The authors made a conclusion that relaparoscopy was an effective little-invasive method of diagnostics and correction of postoperative complications.     

Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice

Background: Although the laparoscopic totally extraperitoneal (TEP) approach to hernia repair has been associated with less pain and a faster postoperative recovery than traditional open repair, many practicing surgeons have been reluctant to adopt this technique because of the lengthy operative times and the learning curve for this procedure. Methods: Data from all patients undergoing TEP repair since 1997 and open mesh repair (OPEN) since 1999 were collected prospectively. Selection of surgical approach was based on local hernia factors, anesthetic risk, previous abdominal surgery, and patient preference. Statistical analyses were performed using unpaired t-tests and chi-squared tests. Data are mean ± SD. Results: TEP repairs were performed in 147 patients and open repairs in 198 patients. Patients in the OPEN group were significantly older (59 ± 19 years OPEN vs 51 ± 13 years TEP) and had a higher ASA (1.9 ± 0.7 OPEN vs 1.5 ± 0.6 TEP; p < 0.01). TEP repairs were more likely to be carried out for bilateral (33% TEP, 5% OPEN) or recurrent hernias (31% TEP, 11% OPEN) than were open repairs (p < 0.01). Concurrent procedures accompanied 31% of TEP and 12% of OPEN repairs (p < 0.01). Operative times (min) were significantly shorter in the TEP group for both unilateral (63 ± 22 TEP, 70 ± 20 OPEN; p = 0.02) and bilateral (78 ± 27 TEP, 102 ± 27 OPEN; p = 0.01) repairs. Mean operative times decreased over time in the TEP group for both unilateral and bilateral repairs (p < 0.01). Patients undergoing TEP were more likely (p < 0.01) to develop urinary retention (7.9% TEP, 1.1% OPEN), but were less likely (p < 0.01) to have skin numbness (2.8% TEP, 35.8% OPEN) or prolonged groin discomfort (1.4% TEP, 5.3% OPEN). Conclusions: Despite a higher proportion of patients undergoing bilateral repairs, recurrent hernia repair, and concurrent procedures, operative times are shorter for laparoscopic TEP repair than for open mesh repair. TEP repairs can be performed efficiently and without major complications, even when the learning curve is included. Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, March 2003, Los Angeles, CA, USA     

腹腔镜腹股沟疝修补术46例护理体会

目的探讨腹腔镜腹股沟疝修补术的围手术期护理。方法回顾性分析2005年1月-2007年5月间46例腹腔镜腹股沟疝修补术患者的临床资料,对围手术期护理经验进行总结。结果本组手术时间42.0±9.6min(20～90min)。住院时间2.8±0.8d(2～9d)。术后6h可离床活动。术后仅有轻微疼痛,并发症6例,其中尿潴留3例,阴囊水肿2例,暂时性神经感觉异常1例。术后随访3～40月,无一例复发。结论腹腔镜疝修补术是治疗腹股沟疝安全、有效的新方法,做好围手术期的护理对降低和预防术后并发症及术后复发率具有重要意义。     

腹股沟疝腹腔镜腹腔内网片植入术后并发症的分析

目的 探讨腹腔镜下腹腔内网片植入术(intraperitoneal onlay mesh,IPOM)治疗腹股沟疝并发症的原因及预防.方法 回顾性分析2005年5月至2009年2月在我院行腹腔镜下腹腔内网片植入术治疗腹股沟疝患者335例.结果 术后疼痛3例,占0.90%;复发3例,复发率0.90%;血清肿2例,占0.60%;术后无1例出现补片感染及粘连性肠梗阻临床表现.结论 腹腔镜下腹腔内网片植入术治疗腹股沟疝方法简单,创伤小,术后并发症少,是一种安全的微创治疗腹股沟疝的手术方法,随着手术技巧的提高,并发症可进一步减少.     

Gasless single-incision laparoscopic inguinal hernia repair: initial experience

Purpose

Laparoscopic hernioplasty has been gaining its popularity in the past decade for its rapid recovery. Single-incision surgery, as its possible advancement, has also received more attention. Traditional laparoscopic surgery with carbon dioxide insufflation precluded patients with underlying cardiovascular or pulmonary disease from minimal invasive surgery. We report our early experience with gasless single-incision laparoscopic inguinal hernia repair via totally extraperitoneal (TEP) approach.

Methods

Between 2010 and 2012, 15 consecutive patients underwent gasless laparoscopic inguinal hernia repair by the same surgeon, using abdominal wall lifting technique with a self-tailored device. Patient demographics, hernia characteristics, operative findings and postoperative outcomes were analyzed prospectively.

Results

Of the 15 patients, all had unilateral hernia. Two presented with acute incarceration, in which one required bowel resection. There was no conversion to open surgery or insertion of additional ports. The median operating time was 80 min (range 51–130) for elective repair and 178 min (range 135–220) for emergency repair. The median hospital stay was 1 day (range 1–6) with minimal requirement of analgesics. Median time taken to resume normal activity was 2 days (range 1–6). No major medical complications or mesh infection was encountered. One patient developed hematoma and was successfully managed by salvage laparoscopic reoperation. During a median follow-up of 54 months (range 38–60), none experienced recurrence.

Conclusion

Gasless single-incision TEP is feasible with favorable results, even in high-risk patients with compromised cardiorespiratory status. This technique can also be applied to emergency setting in patients with incarcerated inguinal hernia requiring bowel resection. Future large scale randomized study is needed to verify the effectiveness of this technique.

     

腹腔镜腹股沟疝修补术后复发疝再次腹腔镜经腹腹膜前疝修补术的经验

目的总结腹腔镜腹股沟疝修补术（laparoscopic inguinal hernia repair,LIHR）后复发,应用腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal,TAPP）进行再次修补的临床经验。 方法回顾性分析2010年3月至2018年6月,广西医科大学第二附属医院收治的既往LIHR术后复发55例患者的临床资料,均行TAPP再次修补。术中在高位T型离断疝囊,旷置远端疝囊及既往补片,重新放置补片。 结果手术均顺利完成,无中转手术,平均手术时间（60.2±18.1）min,术后住院时间1～5 d,术后尿潴留3例（5.5%）,腹股沟区血清肿3例（5.5%）;无肠道损伤、膀胱损伤,无补片感染;电话或信件随访4～28个月,无再次复发患者。 结论T型离断疝囊、旷置补片的TAPP术治疗既往LIHR术后复发的腹股沟疝患者是可行的,由于高位T型离断疝囊,避免剥离既往手术创面,旷置原补片,使得手术更为安全。     

Open versus laparoscopic treatment in inguinal hernia. Our experience

The knowledge acquired in recent years in the field of etiopathogenesis of materials for prosthesis and of surgical technics regarding inguinal hernias together with a renewed interest for local-regional anesthesia has created a real revolution in a field that for almost 100 years had been dominated by the same uncontrasted ideas. The fundamental stages in the evolution of surgical technics are reviewed as well as the most recent discoveries in the field of biochemical textiles and prosthesis available today that have contributed to the development of new surgical methods. These, distinguishing between "open" and laparoscopic technics, are compared on the basis of the data found in the literature concerning recurrence, morbidity, period of convalescence and costs. Personal experience concerns the last four years with 632 patients treated, some in emergency conditions and others in programmed operations, using the foremost methods of "open" surgery but preferring, among these, those that are tension free. The follow-up involved 84% of the patients for a period of no less than 18 months. A reduction of complications and of relapses was obtained: 5-9% in traditional operations against 0.5% for those that were tension free. With this type of operation the postoperative hospitalization was considerably reduced so that 35% of them could fit into the "one day surgery" category. On the basis of these results it is stressed that both the laparoscopic technics and the tension free technics offer advantages as compared to so called traditional methods; however, even though the first type seems to assure a shorter postoperative period, there is the inconvenience of higher costs and the necessity of general anesthesia.     

Perioperative outcomes and complications of laparoscopic ventral hernia repair

BACKGROUND: Laparoscopic techniques are being used increasingly in the repair of ventral hernias and offer the potential benefits of a shorter hospital stay, decreased wound complications, and possibly a lower recurrence rate. Despite good results from high-volume centers, significant complications may occur with this approach and the morbidity of incisional hernia repair may be underestimated. The purpose of this study was to review our experience with laparoscopic ventral hernia repair (LVHR) since its inception at our institution. METHODS: Medical records of all patients who underwent LVHR at a single institution from May 2000 through December 2003 were reviewed. Preoperative and postoperative variables including complications were analyzed. Follow-up evaluation was by office visit and phone survey with assessment of patient satisfaction scores. Data are expressed as mean +/- SD. RESULTS: A total of 121 LVHR were performed in 116 patients (52 men, 64 women; mean age, 57 +/- 13 y; mean body mass index, 35 +/- 8). Hernias were recurrent in 35 cases (28.9%), with a mean of 1.4 prior repairs (range, 1-7). The mean defect size was 109 +/- 126 cm2 and the average mesh size used was 256 +/- 192 cm2. Operating time was 147 +/- 45 minutes, and the hospital stay averaged 1.7 +/- 1 days. Twelve cases (9.9%) were converted to open operation, most commonly because of extensive adhesions. Extensive laparoscopic adhesiolysis was necessary in 29 cases (26.6%). Overall, perioperative complications occurred in 33 cases (27.3%), 13 of which (39.3%) were persistent seromas. Major complications were seen in 9 cases (7.4%). There were 4 enterotomies (3.3%): 3 occurred as a result of adhesiolysis and 1 resulted from a trocar injury; 2 were detected intraoperatively and were converted to open operation and 2 presented postoperatively. One of these patients developed sepsis and died. Follow-up evaluation was available for 83.6% of cases at a mean interval of 22 +/- 16 months after repair. The hernia recurrence rate was 9.3% (9 cases) and was detected at a median of 6 months postoperatively. The overall patient satisfaction score was high at 4.3 +/- 1.1 (scale, 1-5). CONCLUSIONS: Laparoscopic repair is effective for the vast majority of patients with primary or recurrent ventral hernias and results in hernia recurrence rates of less than 10%, with high patient satisfaction scores. Although seroma is the most common complication, major morbidity occurred in 7.4% of the patients in our series. Enterotomy is the most common serious complication and may result in sepsis and death.     

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair

Purpose

Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs. open outcomes and costs.

Methods

The National Surgical Quality Improvement Program (NSQIP) was used to compare durations of surgery, anesthesia time, and length of stay (LOS). The University HealthSystem Consortium (UHC) was used to review the cost and complications between approaches. Patients were matched on demographics, year of procedure and surgical approach between datasets for statistical analysis.

Results

A sample of 5468 patients undergoing OIHR (N = 4,693) or LIHR (N = 775) was selected from UHC from 2008–2011. An identical number of patients from NSQIP were matched to those from UHC resulting in a total of 10,936 records. LIHR patients had shorter duration of wait from admission to operation (p < 0.05). Conversely, LIHR patients had longer operating time (p < 0.05), duration of anesthesia (p < 0.05), and time in the operating room (p < 0.05).Overall complication rate was higher in open (3.1 vs. 1.8 %, p < 0.05). Cost favored open over LIHR ($4360 vs $5105). The cost discrepancy mainly stemmed from LIHR supplies ($1448 vs. $340; p < 0.05) and OR services ($1380 vs. $1080; p < 0.05).

Conclusion

This study demonstrates the LOS and perioperative outcomes were superior in the LIHR group; however, the overall cost was higher due to the supplies. Advancement in technology, surgeons’ skill level and preference of supplies are all factors in decreasing the overall cost of LIHR.

     

小儿腹股沟嵌顿性斜疝腹腔镜治疗体会

目的:探讨小儿腹股沟嵌顿疝腹腔镜手术的临床价值。方法:回顾分析2004年12月至2012年12月为73例腹股沟嵌顿疝患儿行腹腔镜治疗的临床资料,患儿均在全身麻醉下行腹腔镜疝囊高位结扎术,腹横筋膜上内环口缺损较大时利用脐侧韧带缩小内环口。结果:73例手术均顺利完成。手术时间10～120 min,平均(45.9±24.5)min;住院2～12 d,平均(4.5±2.0)d。随访65例,复发1例。术中行内环口修补者均无复发。结论:腹腔镜手术治疗小儿腹股沟嵌顿疝损伤小、并发症少、术后康复快,术中可同时处理对侧腹股沟隐匿性疝,在结扎疝囊颈的基础上利用脐侧韧带进行内环口修补可减少复发,手术操作简单,安全可行。     

腹腔镜完全腹膜外疝修补术治疗腹股沟疝的疗效

目的总结腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal,TEP）治疗腹股沟疝患者临床体会。 方法回顾性分析2012年12月至2016年12月,中山市中医院采用TEP治疗成人腹股沟疝737例患者的临床资料,分析TEP术式对腹股沟疝患者的影响。 结果本组患者均顺利完成手术,其中12例嵌顿疝自内环口处行小切口回纳疝内容后再行TEP。手者行术时间（46±20）min,15例术后放置引流管,住院时间4～6 d,术后阴囊气肿3例,血清肿、阴囊血肿6例,随访11～59个月,复发2例。 结论TEP术是治疗腹股沟疝安全有效的术式,术后复发率低、恢复快,TEP是目前治疗腹股沟疝的重要术式。     

Urological complications of laparoscopic inguinal hernia repair: a case series

Objectives  

To illustrate urological complications of laparoscopic inguinal hernia repair and discuss their management.