Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children

Jukić, Miro; Pogorelić, Zenon; Šupe‐Domić, Daniela; Jerončić, Ana

doi:10.1007/s00464-018-06611-y

Cited by 29 publications

(40 citation statements)

References 17 publications

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“…It has also been associated with increased postoperative pain and a higher recurrence rate [6,18]. PIRS has been associated with a decreased level of pain due to decreased surgical stress and inflammatory response [4,8]. Medians of surgical times for unilateral and bilateral repairs using PIRS technique are 11 to 19 min and 18 to 24 min, respectively [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

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Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

et al. 2021

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Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

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Section: Discussionmentioning

confidence: 99%

“…Several benefits have been reported including shorter operative time, better cosmetics, no need for tracheal intubation, lower recurrence rates and less possibility of complications [3][4][5][6][7]. A significantly lower level of pain and inflammatory stress response has been reported using the PIRS technique [4,8].…”

Section: Introductionmentioning

confidence: 99%

Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

et al. 2021

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“…Glial activation and neuronal hyperexcitability in cortical and subcortical areas may stimulate apoptosis and neuronal damage, especially in PT infants [21,29]. Laparoscopic inguinal hernia repair techniques are associated with a significantly lower surgical trauma and acute inflammatory stress response in comparison to open hernia repair [30]. Contrary to the above findings, some authors failed to demonstrate any significant neurodevelopmental effects of general anesthesia [31].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.

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“…Inguinal hernia repair is one of the most common surgical procedures performed in children worldwide [3, 4]. Inguinal hernia is a relatively common surgical problem in children, with a reported incidence ranging from 0.5 to 4.5% [5, 6]. The cumulative incidence of inguinal hernia repair is 7% in male patients and 1% in female patients for children aged less than 15 years [7].…”

Section: Discussionmentioning

confidence: 99%

A rare content of congenital inguinal hernia: a case report of splenogonadal fusion

et al. 2019

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BackgroundSplenogonadal fusion (SGF) is a rare congenital malformation that occurs during embryonic development. SGF typically presents as a left-sided scrotal swelling, left inguinal hernia, scrotal mass, or cryptorchidism. Therefore, it is easily misdiagnosed, and unnecessary orchiectomy may occur. This study aimed to report a rare case of SGF.Case presentationA 5-month-old male child presented with a history of obvious left scrotal swelling for 1 month, which progressively worsened 10 h before the hospital visit. The ultrasound examination exhibited a solid mass in the left scrotum, with echo quite similar to that in the testicle and went up into the abdominal cavity through an identical echogenic band structure. After surgical resection, the pathological examination confirmed that the submitted tissue was spleen tissue with extensive bleeding.ConclusionUltrasound can provide important information regarding the diagnosis of SGF. The possibility of SGF should be considered for further differential diagnosis in the case of similar patients.

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Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children

Cited by 29 publications

References 17 publications

Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis

A rare content of congenital inguinal hernia: a case report of splenogonadal fusion

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