| Abstract | Background: 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.
Methods: All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in a prospective cohort study. Patients' age at the time of surgery, gender, BMI, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, intraoperative or postoperative complications and recurrences were recorded.
Results: A total number of 228 inguinal hernia repairs were performed in 188 children (126 (67%) males and 62 (33%) females) with a median age of 4 (IQR 2, 6) years and median follow-up of 46 months. Right-side predominance was noted with 99 (52.7%) right hernia repairs, 49 (26.1%) left hernia repairs, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR 8, 12) min for unilateral and 16 (IQR 14, 20) min for bilateral repair. Median level of pneumoperitoneum was 8 (IQR 7, 8) mmHg. Median hospital stay was 24 (IQR 8, 24) hours. Regarding intraoperative complications only three (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in three male children hydrocele was recorded, in two cases hydrocele resolved spontaneously and one required surgical treatment. No cases of suture granuloma, groin traction pain discomfort, deferent duct injury, umbilical hernia, iatrogenic cryptorchidism, testicular atrophy or recurrence were recorded.
Conclusion: 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 recurrences rates. |
| Abstract (croatian) | Cilj istraživanja: Perkutana plastika unutarnjeg otvora preponskog kanala (PIRS) je minimalno invazivna kirurška tehnika liječenja preponske kile u djece, koja se provodi pod nadzorom laparoskopa postavljenog u umbilikalnoj regiji. Cilj ove studije je procijena učinkovitosti i ishoda liječenja preponske kile u djece korištenjem PIRS metode.
Ispitanici i metode: Sva djeca koja su operirana zbog preponske kile PIRS metodom, u razdoblju od 1. veljače 2015. do 1. veljače 2020. godine, uključena su u prospektivno kohortno istraživanje. Svakom djetetu zabilježene su slijedeće varijable: dob, spol, BMI, lateralizacija kile, duljina trajanja operacijskog zahvata i anestezije, razina pneumoperitoneuma, dodatno uvođenje trokara, duljina boravka u bolnici, intraoperacijske i/ili poslijeoperacijske komplikacije i recidivi.
Rezultati: Ukupno je korištenjem PIRS metode operirano 228 kila u 188 djece (126 (67%) dječaka i 62 (33%) djevojčice) sa medijanom dobi od 4 (IQR 2, 6) godine i medijanom praćenja od 46 mjeseci. Desnostrana kila zabilježena je u 99 (52,7%), lijevostrana u 49 (26,1%) i obostrana u 40 (21,2%) djece. Medijan duljine trajanja operacijskog zahvata iznosio je 10 (IQR 8, 12) min za jednostrane i 16 (IQR 14, 20) min za obostrane kile. Medijan razine pneumoperitoneuma bio je 8 (IQR 7, 8) mmHg. Medijan duljine trajanja bolničkog liječenja bio je 24 (IQR 8, 24) h. Zabilježene su tri (1,3%) intraoperacijske komplikacije i to ozljede epigastričnih vena, koje su liječene konzervativno kompresijom, bez posljedica. Tijekom razdoblja praćenja, u troje muške djece zabilježena je hidrokela, u dva dječaka hidrokela se spontano povukla, dok je u jednog bio potreban kirurški zahvat. Nisu zabilježeni slučajevi granuloma u području kirurškog šava, boli u preponi, oštećenja duktusa deferensa, pupčane kile, jatrogenog kriptorhizma, atrofije testisa ili recidiva.
Zaključci: PIRS je jednostavna, sigurna i učinkovita kirurška tehnika liječenja preponske kile u djece s izvrsnim ishodima liječenja i estetskim rezultatima te niskom učestalošću komplikacija i recidiva. |
