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Cheng PL, Duh YC, Chen JJ, Huang FH. Laparoscopic Extraperitoneal Hernia Repair Versus Open Repair in Boys with Inguinal Hernia: A Meta-analysis. J Pediatr Surg 2023:S0022-3468(23)00090-8. [PMID: 36898876 DOI: 10.1016/j.jpedsurg.2023.01.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Pediatric inguinal hernia is a common surgical problem in boys. Open hernia repair surgery (OH) has been traditionally used to treat this condition, but it leads to complications, such as testicular complications. Laparoscopic hernia repair by using the extraperitoneal method (LHE) is performed through the percutaneous insertion of sutures and extracorporeal closure of patent vaginalis processus; thus, injury to spermatic cord structures is avoided. However, a meta-analysis comparing LHE and OH is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. A meta-analysis of the retrieved studies was performed, and a random-effects model was used to calculate the pooled effect size. The primary outcome was testicular complications, including ascending testis, hydrocele, and testicular atrophy. The secondary outcomes were surgical metachronous contralateral inguinal hernia (MCIH), ipsilateral hernia recurrence, and operation time. RESULTS In total, 6 randomized controlled trials (RCTs) and 20 non-RCTs involving 17,555 boys were included. The incidence of ascending testis (risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.18-0.78; p = 0.008) and MCIH (RR: 0.17, 95% CI: 0.07-0.43; p = 0.0002) was significantly lower in LHE than in OH. The incidence of hydrocele, testicular atrophy, and ipsilateral hernia recurrence did not differ between LHE and OH. CONCLUSION Compared with OH, LHE led to fewer or equivalent testicular complications without increasing ipsilateral hernia recurrence. Moreover, MCIH incidence was lower in LHE than in OH. Hence, LHE could be a feasible choice with less invasiveness for inguinal hernia repair in boys. LEVEL OF EVIDENCE Treatment study, LEVEL III.
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Affiliation(s)
- Po-Lung Cheng
- Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yih-Cherng Duh
- Division of Pediatric Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jeng-Jung Chen
- Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu City, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
| | - Fu-Huan Huang
- Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan.
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Wolak PK, Strzelecka A, Piotrowska - Gall A, Wolak PP, Piotrowska I, Dąbrowska K, Wróbel J, Nowak-Starz G. Percutaneous Internal Ring Suturing (PIRS) – The Benefits of Laparoscopic Inguinal Hernia Repair. Ther Clin Risk Manag 2022; 18:135-144. [PMID: 35237037 PMCID: PMC8882976 DOI: 10.2147/tcrm.s348197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery. Purpose The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques. Patients and Methods We conducted a retrospective study that included children aged 0–18 treated using the PIRS technique in 2008–2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method. Results The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia. Conclusion The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.
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Affiliation(s)
- Przemysław Karol Wolak
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
- Correspondence: Przemysław Karol Wolak, Tel +48 501 525 549, Email
| | | | - Aneta Piotrowska - Gall
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
- Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland
| | | | | | - Katarzyna Dąbrowska
- Department of Neonatology and Neonatal Intensive Care, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Joanna Wróbel
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings. Diagnostics (Basel) 2022; 12:diagnostics12020353. [PMID: 35204443 PMCID: PMC8871209 DOI: 10.3390/diagnostics12020353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.
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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020321. [PMID: 35054015 PMCID: PMC8781267 DOI: 10.3390/jcm11020321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. SUMMARY BACKGROUND DATA Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. RESULTS Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: -11.90 min, 95% CI: -16.63 to -7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. CONCLUSIONS LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.
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Pogorelić Z, Batinović T, Jukić M, Šušnjar T. Percutaneous Internal Ring Suturing is a Safe and Effective Method for Inguinal Hernia Repair in Young Adolescents. J Laparoendosc Adv Surg Tech A 2022; 32:452-457. [PMID: 34990282 DOI: 10.1089/lap.2021.0393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Percutaneous internal ring suturing (PIRS) is a laparoscopic procedure that has demonstrated its safety and efficacy as a method of hernia repair in younger children but without evidence among the adolescent population. The aim of this study was to determine the success of PIRS outcomes for hernia repair in the adolescent population. Methods: All adolescents who were operated on using the PIRS method for inguinal repair during the 5-year study period in a single center were included in a prospective cohort study. The main outcome of the study included treatment outcomes in a term of recurrence rate. The secondary outcomes include other treatment outcomes such as complications, conversion to an open procedure, and reoperation rates, as well as duration of anesthesia and surgery, duration of hospital admission, and the level of carbon dioxide pneumoperitoneum. Results: In 51 adolescents (72.5% males) with a median age of 13 years and median follow-up of 44 months, a total of 57 PIRS procedures were performed. There were 30 (58.8%) right hernia repairs, 15 (29.4%) left hernia repairs, and 6 (11.8%) bilateral hernia repairs. The median surgical time was 10 minutes for unilateral and 18 minutes for bilateral hernia repair. The median length of hospital stay was 24 hours. Only one (1.95%) intraoperative complication occurred during surgery, an inferior epigastric vein injury. No complications or recurrences were observed during the follow-up period. Conclusions: PIRS has proven to be simple, safe, and effective method for groin hernia repair in adolescent population. This method provides excellent overall and cosmetic outcomes. There is a low incidence of complications and recurrences. According to our results, PIRS could be considered to become a possible approach for groin hernia repair in adolescents.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Tina Batinović
- Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Tomislav Šušnjar
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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Ji Y, Li Y, Zhang X, Qiu T, Chen S, Xu Z. Transumbilical Single-Site Laparoscopic Intraperitoneal Closure of the Internal Inguinal Ring for Pediatric Inguinal Hernia. Front Pediatr 2022; 10:855537. [PMID: 35372171 PMCID: PMC8964975 DOI: 10.3389/fped.2022.855537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A new novel technique for pediatric inguinal hernia (PIH) repair, namely, transumbilical single-site laparoscopic intraperitoneal closure (TUSLIC) of the internal inguinal ring (IIR) with a single instrument, was introduced. The short-term follow-up of TUSLIC for PIH was compared with that of transabdominal multiple-site laparoscopic extraperitoneal closure (TAMLEC) for PIH. METHODS Descriptive variables, perioperative clinical features, and short-term outcomes were retrospectively analyzed and compared between the patients who underwent TUSLIC and those who underwent TAMLEC. RESULTS In total, 289 patients were enrolled in this study. Of these, 190 patients received TUSLIC, and 99 patients received TAMLEC. The descriptive variables (including sex, age, weight, and preoperative diagnosis of patients) were comparable between the two groups (P-values were 0.12, 0.71, 0.69, and 0.23, respectively). The mean operative times for unilateral hernia repair and bilateral hernia repairs in TAMLEC group were significantly less than those in TUSLIC group (P < 0.01). The values of surgical site infection, umbilical bleeding, testicular atrophy, iatrogenic ascent of the testis, and secondary hydrocele were not significantly different between the two groups. There were no suture granulomas, and recurrence occurred in TUSLIC group, though at a significantly lower rate than in TAMLEC group (P < 0.05). CONCLUSIONS TUSLIC is a feasible, safe, and reliable minimally invasive method for PIH. Compared with TAMLEC, TUSLIC has the advantages of minimized complications and a low recurrence rate.
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Affiliation(s)
- Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yanan Li
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zhicheng Xu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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Tanasescu C, Moisin A, Mihetiu A, Serban D, Costache A, Bratu DG. The use of polypropylene mesh in inguinal hernia surgery: A retrospective study. Exp Ther Med 2021; 22:1193. [PMID: 34475983 PMCID: PMC8406872 DOI: 10.3892/etm.2021.10627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 01/18/2023] Open
Abstract
Previously, inguinal hernia surgery was based exclusively on repairing the abdominal wall defects using the patient's own tissues, which were put in contact with and tensioned to recalibrate the natural orifices. At present, inguinal hernia surgery is based almost solely on mounting an allograft, which has the role of strengthening the weakened groin region that allowed the herniation. This modern method of operation on inguinal hernia can be performed in a classic or laparoscopic manner. The mesh is made of polypropylene, which is a polymer of cyclic hydrocarbons. The aim of the present study was to evaluate the effectiveness, biocompatibility, as well as the immediate and long-term complications in textile allografts used in open surgery of inguinal hernia repair. Another aim was to demonstrate once again the superiority of low-weight meshes with large pores by decreasing the number of complications caused by the synthetic material used, but also by a decrease in the tension on the tissues to which it was fixed. The present study included 255 cases submitted to inguinal hernia surgery. Only 1.5% required immediate reintervention before discharge to evacuate hematoma. The short duration of hospitalization, the quality-price ratio, the good postoperative results, as well as the rapid socio-professional reintegration, render the use of polypropylene mesh in inguinal hernia surgery very attractive for patients.
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Affiliation(s)
- Ciprian Tanasescu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
| | - Andrei Moisin
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania
| | - Alin Mihetiu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
| | - Dragos Serban
- The 4th Surgery Department, Emergency University Hospital, 050098 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dan Georgian Bratu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
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