Comparison Study of Three Laparoscopic Ligation Procedures for Pediatric Inguinal Hernia: a Multicenter Cohort of 5523 Cases

Overview

Journal Hernia

Publisher Springer

Date 2022 May 3

PMID 35504975

Authors

Z B Luo

X C Xiang

Z Y Du

H G Shi

S Q Chi

D H Yang

K Li

S Li

S T Tang

Affiliations

Soon will be listed here.

Abstract

Purpose: Single-site laparoscopic percutaneous extraperitoneal ligation (SLPEL) for pediatric inguinal hernia has gained popularity worldwide. However, complications associated with extraperitoneal knotting are not rare. This study evaluated the effectiveness of a modified SLPEL (M-SLPEL) to decrease adverse events associated with ligation knotting by comparing it with two other methods: classical SLPEL (C-SLPEL) and intracorporeal purse-string suturing (IPS).

Methods: A multicenter retrospective comparative study was conducted among 5523 pediatric inguinal hernia patients. Cases were divided into three groups according to the surgical procedure: the M-SLPEL, C-SLPEL, and IPS groups. Data describing the clinical characteristics, operative time, and complications were collected.

Results: All procedures were performed uneventfully. There were no significant differences in the age at operation (mean 2.62 ± 1.38 years). The operative time was shorter in the M-SLPEL group both for unilateral hernias (12.5 ± 1.8 min in C-SLPEL, 11.7 ± 1.3 min in M-SLPEL, and 17.6 ± 2.9 min in IPS) and for bilateral hernias (15.1 ± 2.1 min, 14.6 ± 1.7 min, and 23.9 ± 2.3 min, respectively). The overall incidence of adverse events in the inguinal region was 0% for M-SLPEL, 2.2% for C-SLPEL, and 0.5% for IPS. All patients were followed up for 12-93 months (mean 54 months). Recurrence occurred in 8 cases in the C-SLPEL group, 1 case in the M-SLPEL group, and 8 cases in the IPS group, with no significance between groups. No scrotal hematoma, testicular atrophy, or iatrogenic cryptorchidism occurred in any group.

Conclusion: The M-SLPEL procedure has time-consumption efficiency equivalent to that of C-SLPEL and even fewer adverse events in the inguinal region than IPS and C-SLPEL.

Citing Articles

Outcomes from a new modified single needle laparoscopic percutaneous extraperitoneal closure and cut off for pediatric inguinal hernia.

Zeng D, Pu C, Guo C, Kong X Sci Rep. 2024; 14(1):12029.

PMID: 38797731 PMC: 11128452. DOI: 10.1038/s41598-024-62769-7.

References

Yonggang H, Changfu Q, Ping W, Fangjie Z, Hao W, Zicheng G . Single-port laparoscopic percutaneous extraperitoneal closure of inguinal hernia using "two-hooked" core needle apparatus in children. Hernia. 2019; 23(6):1267-1273. DOI: 10.1007/s10029-019-01933-9. View

Wang Y, Zhang Q, Chen L, Lin Y, Zhang J, Wu D . Laparoscopic Percutaneous Extraperitoneal Internal Ring Closure for Pediatric Inguinal Hernia: 1,142 Cases. J Laparoendosc Adv Surg Tech A. 2019; 29(6):845-851. DOI: 10.1089/lap.2018.0721. View

Chu C, Chen J, Shen Y, Liu S, Sun L, Nie Y . Individualized treatment of pediatric inguinal hernia reduces adolescent recurrence rate: an analysis of 3006 cases. Surg Today. 2019; 50(5):499-508. DOI: 10.1007/s00595-019-01940-4. View

Esposito C, Escolino M, Settimi A . Laparoscopic Pediatric Inguinal Hernia Repair Using Purse-String Suture: Technical Recommendations After 20 Years Experience. J Laparoendosc Adv Surg Tech A. 2016; 26(9):748-9. DOI: 10.1089/lap.2016.0257. View

Li S, Tang S, Aubdoollah T, Li S, Li K, Tong Q . A Modified Approach for Inguinal Hernias in Children: Hybrid Single-Incision Laparoscopic Intraperitoneal Ligation. J Laparoendosc Adv Surg Tech A. 2015; 25(8):689-93. DOI: 10.1089/lap.2014.0474. View

McClain L, Streck C, Lesher A, Cina R, Hebra A . Laparoscopic needle-assisted inguinal hernia repair in 495 children. Surg Endosc. 2014; 29(4):781-6. DOI: 10.1007/s00464-014-3739-8. View

Uchida H, Kawashima H, Goto C, Sato K, Yoshida M, Takazawa S . Inguinal hernia repair in children using single-incision laparoscopic-assisted percutaneous extraperitoneal closure. J Pediatr Surg. 2010; 45(12):2386-9. DOI: 10.1016/j.jpedsurg.2010.08.037. View

Shalaby R, Elsayaad I, Alsamahy O, Ibrahem R, El-Saied A, Ismail M . One trocar needlescopic assisted inguinal hernia repair in children: a novel technique. J Pediatr Surg. 2017; . DOI: 10.1016/j.jpedsurg.2017.08.020. View

Shalaby R, Elsaied A, Shehata S, Shehata S, Hamed A, Alsamahy O . Needlescopic assisted internal ring suturing; a novel application of low-cost home-made instruments for pediatric inguinal hernia repair. Hernia. 2019; 23(6):1279-1289. DOI: 10.1007/s10029-019-01982-0. View

10.

Li S, Li M, Wong K, Liu L, Tam P . Laparoscopically assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children. J Pediatr Surg. 2014; 49(12):1818-20. DOI: 10.1016/j.jpedsurg.2014.09.027. View

11.

Yan X, Kuang H, Zheng N, Yang J, Duan X, Zhu Z . Single-puncture Method of Laparoscopic Herniorrhaphy in Children. Chin Med J (Engl). 2016; 129(16):2015-6. PMC: 4989440. DOI: 10.4103/0366-6999.187860. View

12.

Li S, Luo Z, Tu J, Tang S . Novel modification of laparoscope-assisted inguinal hernia ligation to decrease knotting associated complications. J Pediatr Surg. 2021; 56(12):2412-2413. DOI: 10.1016/j.jpedsurg.2021.08.012. View

13.

Takehara H, Yakabe S, Kameoka K . Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg. 2006; 41(12):1999-2003. DOI: 10.1016/j.jpedsurg.2006.08.032. View

14.

Xu C, Xiang B, Jin S, Luo Q, Zhong L . Transumbilical two-port laparoscopic percutaneous extraperitoneal closure: a new technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A. 2013; 23(4):392-6. DOI: 10.1089/lap.2012.0456. View

15.

Li B, Nie X, Xie H, Gong D . Modified single-port laparoscopic herniorrhaphy for pediatric inguinal hernias: based on 1,107 cases in China. Surg Endosc. 2012; 26(12):3663-8. DOI: 10.1007/s00464-012-2396-z. View

16.

Chang Y, Lee J, Tsai C, Chiu W, Chiou C . Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children. J Laparoendosc Adv Surg Tech A. 2011; 21(3):277-82. DOI: 10.1089/lap.2010.0132. View

17.

Wang D, Yang P, Yang L, Jin S, Yang P, Chen Q . Comparison of laparoscopic percutaneous extraperitoneal closure and laparoscopic intracorporeal suture in pediatric hernia repair. J Pediatr Surg. 2020; 56(10):1894-1899. DOI: 10.1016/j.jpedsurg.2020.11.022. View

18.

Shalaby R, Abdalrazek M, Hamed A, Elhady S, Ibrahim R, Shahin M . Novel application of the sewing machine principle; a new simplified intracorporeal suturing technique for pediatric inguinal hernia. J Pediatr Surg. 2019; 54(7):1505-1509. DOI: 10.1016/j.jpedsurg.2019.01.054. View

19.

Shalaby R, Ismail M, Dorgham A, Hefny K, Alsaied G, Gabr K . Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques. J Pediatr Surg. 2010; 45(11):2210-6. DOI: 10.1016/j.jpedsurg.2010.07.004. View

20.

Ozgediz D, Roayaie K, Lee H, Nobuhara K, Farmer D, Bratton B . Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: report of a new technique and early results. Surg Endosc. 2007; 21(8):1327-31. DOI: 10.1007/s00464-007-9202-3. View