Reasons for Recurrence After the Laparoscopic Repair of Indirect Inguinal Hernia in Children

Xiang, Bo; Jin, Shuguang; Zou, Lin; Li, Fuyu; Jiang, Xiaoping; Xu, Zhicheng

doi:10.1089/lap.2014.0401

Cited by 26 publications

(22 citation statements)

References 5 publications

(5 reference statements)

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“…In the literature, PIRS technique had been associated with higher rates of ipsilateral recurrence and residual hydroceles ( 9 , 17 , 18 ) This had been attributed to several factors such as the inexperience of the surgeons, the use of absorbable suture for ligation of the patent processus vaginalis , the use of a single-suture, larger defects and the presence of other factors (i.e., chronic cough, constipation) ( 19 – 21 ). More recent publications report lower recurrence and complications rate ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…After a systematic review and mentorship, the percutaneous internal ring suturing (PIRS) technique ( 11 ) leaving no peritoneal gaps was selected and implemented. It favored our choice, the satisfactory cosmesis and the possibility to identify the patency of the contralateral processus vaginalis ( 17 ); among potential disadvantages, we had some reports mentioning higher rates of complications and recurrence ( 18 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children

et al. 2017

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IntroductionWe analyzed the department and surgeon learning curves during implementation of the percutaneous internal ring suturing (PIRS) technique in our department.MethodsChildren proposed for inguinal hernia or communicating hydrocele repair were included (n = 607). After mentorship, all surgeons were free to propose open or PIRS repair. From gathered data, we assessed department and surgeon learning curves through cumulative experience focusing in perioperative complications, conversion, ipsilateral recurrence, postoperative complications, and metachronous hernia, with benchmarks defined by open repair.ResultsDepartment-centered analysis revealed that perioperative complications, conversion, and ipsilateral recurrence rates were higher in the beginning, reaching the benchmarks when each surgeon performed, at least, 35 laparoscopic repairs. Postoperative complications and metachronous hernia rates were independent from learning curves, with the metachronous hernia rate being significantly lower in PIRS patients. During the program, the percentage of males in those operated by PIRS progressively increased reaching the percentage of males, in our sample, when department operated over 230 cases.ConclusionThirty-five laparoscopic cases per surgeon are required for perioperative complications, conversion, and ipsilateral recurrence reach the benchmark. The gap between the percentage of males, in those operated by PIRS and in those proposed for surgery, monitors the confidence of the team in the program.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children

et al. 2017

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“…How to reduce the recurrence rate after single-port laparoscopic inguinal herniorrhaphy in children is a major problem in clinical practice at present, and the most common causes of recurrence include the learning curve factor, indefinite ligation, and ligature loosening [13,17]. Research shows that although there were individual differences, all trainees acquired the skill to perform LPEC adequately within ten months [18].…”

Section: Discussionmentioning

confidence: 99%

Pediatric inguinal hernia treated by single-port laparoscopic water injection hernia crochet needle.

Zhou

Chen

Jiang

2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Inguinal hernia is the most common disease in pediatric surgery and is induced by congenital processus vaginalis patency. Almost all inguinal hernias are inguinal indirect hernias, and herniorrhaphy has accounted for about 15% of all pediatric operations. In the past 20 years, with the development of minimally invasive technology, laparoscopic inguinal herniorrhaphy has been emerging in China and in other countries. Aim: To introduce a new technique for treating inguinal hernia in children, and evaluate the feasibility and surgical efficacy of a transumbilical single-port laparoscopic water-injection hernia crochet needle in treating pediatric inguinal hernia. Material and methods: Clinical data of 136 inguinal hernial children treated using a transumbilical single-port laparoscopic water-injection hernia crochet needle in our hospital from June 2017 to December 2018 were retrospectively analyzed. Results: All procedures were successfully accomplished, and no case was converted to a different procedure; the average operation time was 16 min for one side and 35 min for both sides. Patients were followed for an average of 10 months after surgery. One patient had a line-knot reaction at the inguinal puncture point 3 months after surgery and recovered after conservative treatment, and no recurrent case was observed after surgery. Conclusions: It is feasible to treat pediatric inguinal hernia through a transumbilical single-port laparoscopic water-injection hernia crochet needle, which is associated with safety, less trauma, rapid recovery, no obvious scar, and satisfactory efficacy. Therefore, it is worthy of being promoted and applied in clinical practice.

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“…Our IH recurrence rate of 0.57% is comparable to the recurrence rate of 0.3% at a high-volume center in the People's Republic of China with a series of over 6,000 pediatric patients, and better than most other pediatric laparoscopic IH series (1.4%-3.1%). [2][3][4][5]…”

Section: Discussionmentioning

confidence: 99%

External squeeze test during pediatric laparoscopic hernia repair: a novel on-table assessment to ensure complete closure of patent processus vaginalis

Aziz¹,

Osman²,

Lim³

et al. 2018

OAS

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Background: In pediatric patients, recurrent inguinal hernia (IH) after laparoscopic repair mostly occurs secondary to incomplete closure of the patent processus vaginalis (PPV). The "external squeeze test" (EST) is a simple on-table assessment tool to check completeness of closure of PPV during laparoscopic IH repair. Patients and methods: A review of effectiveness of EST and recurrence of IH was carried out at our institution from December 2007 to December 2017. Closure of PPV was achieved with creation of purse string over pre-peritoneal fascia of the deep inguinal ring with avoidance of important structures; EST was then performed, that is, a gentle squeeze on the scrotum or labia majora while the telescope remains focused at the pursed area. If the closure was incomplete, EST would result in escape of CO 2 from within the scrotum or labia back into the peritoneal cavity, visualized as air bubbles internally and taken as a positive EST. A complete closure of PPV would not produce any bubbles internally upon external pressure; this would be taken as a negative EST. All patients had 1-to 12-month follow-up. Results: A total of 874 PPVs were repaired. EST was performed in 870 PPVs (99.5%). There were five recurrences of PPVs consistent with recurrent IH (0.57%); one was in a patient with negative EST, attributed to a slipped ligature; the other four did not have EST performed (p<0.000000). All the recurrences were re-repaired laparoscopically. Conclusion: EST is a simple, useful on-table assessment tool which significantly detects completeness of closure of PPV which may prevent recurrence of IH. We highly recommend EST in pediatric laparoscopic hernia repair, especially in large PPV.

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Reasons for Recurrence After the Laparoscopic Repair of Indirect Inguinal Hernia in Children

Abstract: Recurrent hernia still appeared postlaparoscopic inguinal hernia in a small number of patients. The main preventive measures were removal of risk factors for hernia and an appropriate surgical approach.

Cited by 26 publications

References 5 publications

Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children

Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children

Pediatric inguinal hernia treated by single-port laparoscopic water injection hernia crochet needle.

External squeeze test during pediatric laparoscopic hernia repair: a novel on-table assessment to ensure complete closure of patent processus vaginalis

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