Two-trocar needlescopic approach to incarcerated inguinal hernia in children
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Published on: February 10, 2023
Rafik Shalaby1, Abdul Moniem Shams, Soliman Mohamed
1Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Nasr City, 11884, Cairo, Egypt. rafikshalaby@hotmail.com
Insights
Needlescopy is a safe and effective minimally invasive surgical technique for treating incarcerated inguinal hernias in children. This approach allows for direct visualization and repair, reducing operative time and hospital stays.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopy is established for pediatric inguinal hernia repair.
- Needlescopic surgery offers cosmetic and less invasive benefits.
- Limited data exists on needlescopy for incarcerated inguinal hernias.
Purpose of the Study:
- To evaluate the feasibility and outcomes of needlescopy for incarcerated inguinal hernias in children.
Main Methods:
- 250 children (6 months–6 years) with incarcerated inguinal hernias were analyzed.
- Manual reduction was successful in 170 cases; 100 had same-day surgery, 70 had needlescopy later.
- 80 cases with unsuccessful manual reduction underwent urgent needlescopic reduction and herniorrhaphy.
Main Results:
- Needlescopic approach was feasible in all cases; no conversion to open surgery was needed.
- Immediate needlescopic herniorrhaphy was performed without significant increase in operative time (mean 10 minutes).
- No intraoperative complications were reported.
Conclusions:
- Needlescopy is a feasible, safe, easy, and preferable option for pediatric incarcerated inguinal hernias compared to open surgery.
- It enables direct visualization and reduction of incarcerated contents.
- Allows simultaneous definitive repair, reducing operative time and hospital stay.
Background:
Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.
Methods:
A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.
Results:
In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.
Conclusions:
The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.