Effects of Laparoscopic Hernia Repair by PIRS (Percutaneous Internal Ring Suturing) Technique on Testicular Artery Blood Supply

Pogorelić, Zenon

doi:10.1080/08941939.2017.1423424

Cited by 6 publications

(3 citation statements)

References 9 publications

(13 reference statements)

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“…In the pediatric population the incidence of recurrence rates following open inguinal hernia repair is 0.5-4% [11,15]. Recurrence rates following standard three port laparoscopic hernia repair is slightly higher and ranges between 0.7-4.5% [16][17][18][19][20][21]. After introduction of PIRS technique the first published reports had been associated with higher recurrence rates and residual hydroceles [4,13].…”

Section: Discussionmentioning

confidence: 99%

“…After introduction of PIRS technique the first published reports had been associated with higher recurrence rates and residual hydroceles [4,13]. This had been influenced by the inexperience of the surgeons, the use of absorbable suture, and the use of a single suture or larger defects [21]. Recently, it has been described that PIRS resulted in a significant reduction of recurrence rates and operative time [2][3][4][5]10].…”

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%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Recent studies clearly demonstrated that testicular vascularization has not been affected by the PIRS procedure. [18][19][20] During the PIRS technique, the peritoneum is reached by a blunt needle under direct vision, avoiding the anatomy of the groin structure, causing less trauma, and leaving almost no surgical incision on the abdominal wall. 2,[4][5][6][7][8][9][10][11][12][13][14][15] Dissection of the sac during the open procedure may damage the spermatic cord structure and cause iatrogenic cryptorchidism, or even testicular atrophy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience

Pogorelić

Čohadžić

Jukić

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Purpose: Percutaneous internal ring suturing (PIRS) is a minimally invasive surgical technique of laparoscopic hernia repair in children under the control of a laparoscope placed in the umbilicus. The aim of this study was to evaluate the management and postoperative outcomes of PIRS for inguinal hernia repair in children.Patients and Methods: All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in the prospective cohort study. The following parameters were recorded: age, gender, body mass index, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, and intraoperative or postoperative complications and recurrences were recorded.Results: A total number of 228 PIRS procedures were performed in 188 children [126 (67%) male individuals and 62 (33%) female individuals] with a median age of 4 [interquartile range (IQR), 2 to 6] years and a median follow-up of 46 (IQR, 38 to 52) months. From the total number of hernia repairs there were 99 (52.7%) right, 49 (26.1%) left, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR, 8 to 12) minutes for unilateral and 16 (IQR, 14 to 20) minutes for a bilateral repair. The median hospital stay was 24 (IQR, 8 to 24) hours. Regarding intraoperative complications, only 3 (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in 3 male children, hydrocele was recorded; in 2 cases, hydrocele resolved spontaneously and 1 required surgical treatment. No cases of other complications including testicular atrophy or recurrence were recorded. Conclusion:In a hands of an experienced pediatric laparoscopic surgeon, PIRS is a simple, safe, and effective technique for inguinal hernia repair in children with excellent outcomes, cosmetic results, and a low incidence of complications and recurrence.

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

et al. 2018

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Effects of Laparoscopic Hernia Repair by PIRS (Percutaneous Internal Ring Suturing) Technique on Testicular Artery Blood Supply

Cited by 6 publications

References 9 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

Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience

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

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