A Modified Approach for Single-Port Laparoscopic Repair of Inguinal Hernias in Children

Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia: Surgical outcome, postoperative complications, and serum inflammation effects

BACKGROUND

Laparoscopic surgery, with the advantage of less trauma, has been predominantly performed to treat pediatric inguinal hernia. However, the traditional three-port laparoscopic surgery remains extremely traumatic for children, whereas single-port laparoscopic surgery causes less damage to children than traditional laparoscopy. However, single-port laparoscopic surgery is more challenging; thus, studies on the effect of its application in pediatric inguinal hernia remain relatively limited.

AIM

To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes, postoperative complications, and serum inflammation in pediatric inguinal hernia.

METHODS

This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children's Hospital, Capital Institute of Pediatrics, from April 2022 to May 2023. Participants were categorized into the observation group (single-incision laparoscopic herniorrhaphy needle, n = 60) and the control group (two-port laparoscopic surgery, n = 53). Comparative analyses involved surgical duration, intraoperative blood loss, and length of hospital stay. C-reactive protein (CRP) and white blood cell count (WBC) levels were measured preoperatively and 24 hours postoperatively. Postoperative pain was evaluated with the face, legs, activity, cry, and Consolability scale. Further, the incidence of complications, recurrence, and reoperation rates was assessed. Logistic regression was employed to determine independent risk factors related to poor prognosis.

RESULTS

The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group (P < 0.05). Both groups demonstrated increased CRP and WBC levels postoperatively, but the observation group exhibited significantly lower levels (P < 0.05). Further, pain scores at 24 hours postoperatively were significantly lower in the observation group (P < 0.05). Additionally, the observation group experienced fewer adverse events, recurrence rates, and reoperations compared to the control group (P < 0.05). Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence (P < 0.05).

CONCLUSION

Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy, effectively reduces postoperative complications, ensures a more concealed surgical incision, and promotes faster postoperative recovery than conventional two-port laparoscopy. This approach merits wider application.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia with prolapsed ovary

BACKGROUND

Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper.

METHODS

We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant.

RESULTS

A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries.

CONCLUSION

Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

Pediatric Inguinal Hernia Repair, Laparoscopic Versus Open Approach: A Systematic Review and Meta-Analysis of the Last 10-Year Evidence

Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone.