Comparison of intra- and extra-corporeal laparoscopic hernia repair in children: A systematic review and pooled data-analysis

Maat, Sanne; Dreuning, Kelly M. A.; Nordkamp, Stefi; Gemert, Wim van; Twisk, Jos W. R.; Visschers, Ruben G.J.; Heurn, Ernst van; Derikx, Joep P. M.

doi:10.1016/j.jpedsurg.2021.01.049

Cited by 21 publications

(12 citation statements)

References 28 publications

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“…Over the last decades, different methods for laparoscopic IHR have been described, including transperitoneal and extraperitoneal techniques. [1,25,26] In our survey 33% of pediatric surgeons prefer transperitoneal technique using only one trocar for the camera. Four different procedures with 2-3 trocars for intracorporal suturing with or without opening the peritoneum are performed in the study period in Germany.…”

Section: Discussionmentioning

confidence: 87%

The Status of Laparoscopic Inguinal Hernia Surgery in Children: A Nationwide Assessment

et al. 2022

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Inguinal hernia repair (IHR) is a common procedure in childhood. Laparoscopic IHR has been evolving for the last three decades. Although clear advantages have been shown, adaptation in Germany has been slow. We aim to study the current status of pediatric laparoscopic IHR. A survey was sent to all 89 pediatric surgical departments in Germany on current practices and preferences of open versus laparoscopic IHR. Two nationwide databases of administrative claims data from 2019 were analyzed and correlated with responses from the survey. A total of 56% of the pediatric surgical departments supplied data through the quality reports. The recall of our survey was 58% of all pediatric surgery departments. According to the pooled data, laparoscopic IHR was performed in 8.2% of all inpatients treated. Laparoscopic IHR was considered a training procedure in 48% of the departments. Five different laparoscopic techniques were described (most commonly percutaneous closure of the hernia under laparoscopic vision). The choice between open and laparoscopic IHR was mainly determined by the child’s age. Currently, only a minority of German children undergo inguinal hernia repair by laparoscopy. More training opportunities in the form of hands-on and video workshops may lead to more widespread employment of the laparoscopic technique.

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Section: Discussionmentioning

confidence: 87%

The Status of Laparoscopic Inguinal Hernia Surgery in Children: A Nationwide Assessment

et al. 2022

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“…[2][3][4]11 Numerous modifications laparoscopic techniques have expanded in the past decade, from multi -port to Single-port, 12,13 with preperitoneal hydrodissection technique, 9,14 into intra-or extra-corporeal closing techniques. 10,15,16 Laparoscopic intra -corporeal suturing technique is the most difficult step in laparoscopic surgery, it needs additional laparoscopic instrument, skilled laparoscopic techniques and long learning curve. 5,10,15 The laparoscopic extra-corporeal closing techniques are easyly operable and yield improvedoutcomes and cosmetic satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula

Lin,

Yan,

Fang

et al. 2024

Surg Innov

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Purpose Numerous modifications laparoscopic techniques have mushroomed in recent years. Here we describe a modified technique of extracorporeal ligation of processus vaginalis in children using a hernia crochet needle with a cannula. Methods Processus vaginalis repair was carried out on patients diagnosed with inguinal hernia or hydroceles using this novel technique between June 2021 and June 2022. The processus vaginalis was closed extracorporeally using a hernia crochet needle with a cannula. In the presence of patent processus vaginalis, the same procedure would be performed on the contralateral side. The primary outcomes was the safety and efficiency of this modified procedure, and the secondary outcomes was the post operative complications. Results A total of 212 (165 inguinal hernia and 47 hydroceles) children were corrected by this novel technique. The mean operation time was 27.49 min for unilateral inguinal hernia cases and 36.55 min for bilateral cases. The unilateral hydrocele median operation time was 27.83 min and that for the bilateral cases was 37.30 min. During the mean of 10.92 months of follow-up, there was only a boy subject to a metachronous contralateral occurrence of hernia 10 months after surgery, and no other complications (knot reactions, testicular atrophy, postoperative hydrocele or iatrogenic) have been observed yet. Conclusion This study shown a unique procedure with using a hernia crochet needle with a cannula to be simple, safe, and effective in managing inguinal hernias and hydroceles in the pediatric population.

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“…Indeed, a systematic review in 2021 by Maat et al reported a longer duration of surgery in intra-corporeal repair compared with extra-corporeal repair, with the need for intra-corporeal suturing and knotting identi ed as the key time-limiting factor. [24] The intra-corporeal suturing and knotting approach places substantial demands on the requirement of hand-eye coordination, particularly in relation to the posterior and medial hemi-circumference of internal rings; major vessels, such as the iliac and inferior epigastric arteries; and the need to avoid important testicular vasculature-for example, the vas deferens and testicular vessels. With the accumulation of experience and various technical re nements, such as hydro-dissection and the "needle sign," clinical outcomes improve and the operative time of the technique decreases.…”

Section: Discussionmentioning

confidence: 99%

Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children

2022

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BackgroundLaparoscopic inguinal hernia repair is one of the procedures most commonly performed by paediatric surgeons. Current research on the learning curve for laparoscopic hernia repair in children is scarce. This study aims to evaluate the clinical outcome and learning curve of laparoscopic intra-corporeal inguinal hernia repair in children. MethodsA retrospective single-centre analysis of all paediatric patients who underwent laparoscopic intracorporeal inguinal hernia repair between 2010 and 2019 was performed. The clinical outcomes were analysed. The data on the achievement of the learning curve by surgical trainees were evaluated with the CUSUM technique, focusing on operative time. ResultsThere were 719 patients with laparoscopic intra-corporeal inguinal hernia repair (comprising 1051 sides) performed during the study period. The overall ipsilateral recurrence rate was 1.8% without other complications detected. CUSUM analysis showed that there were 3 phases of training, for which the trainees underwent initial learning phase (Phase 1) for the rst 7 cases. After mastering of the skills and extrapolating the skills to male patients with smaller body size (Phase 2), they then achieved performance comparable to that of the senior surgeons after 18 procedures (Phase 3). Conclusions18 procedures seem to be the number required to reach the learning curve plateau in terms of operative time by surgical trainees. The clinical outcomes show that laparoscopic intra-corporeal inguinal hernia repair is a safe and transferrable technique, even in the hands of trainees, with adequate supervision and careful case selection. It also provides skill acquisition for minimally invasive surgery.

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Comparison of intra- and extra-corporeal laparoscopic hernia repair in children: A systematic review and pooled data-analysis

Cited by 21 publications

References 28 publications

The Status of Laparoscopic Inguinal Hernia Surgery in Children: A Nationwide Assessment

The Status of Laparoscopic Inguinal Hernia Surgery in Children: A Nationwide Assessment

Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula

Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children

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