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Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment?
Özlem Kara1, Abdullah Yıldız, Hülya Erteşoğlu Toydemir
1Department of Paediatric Surgery, Şişli Etfal Training and Research Hospital, 25240, İstanbul, Turkey.
Insights
Percutaneous internal ring suturing (PIRS) for pediatric inguinal hernias showed no ilioinguinal nerve damage. Conventional open repair in one case resulted in temporary nerve dysfunction, highlighting PIRS as a potentially safer alternative.
Area of Science:
- Pediatric Surgery
- Nerve Function Assessment
- Hernia Repair Techniques
Background:
- Inguinal hernias are common in children.
- Assessing ilioinguinal nerve (IIN) function is crucial after surgical repair to prevent damage.
- Open repair and percutaneous internal ring suturing (PIRS) are common surgical approaches.
Purpose of the Study:
- To evaluate the impact of open versus PIRS techniques on ilioinguinal nerve function in pediatric patients.
- To compare the incidence of ilioinguinal nerve damage between the two surgical methods.
Main Methods:
- A prospective clinical trial involving 60 pediatric patients undergoing inguinal hernia repair.
- Patients were divided into two groups: PIRS (n=35) and conventional open repair (n=22).
- Peripheral electromyography (EMG) was used to assess ilioinguinal nerve stimuli preoperatively and at the third postoperative week.
Main Results:
- All patients (35) who underwent PIRS repair showed normal pre- and postoperative EMG results for the ilioinguinal nerve.
- In the open repair group (22 patients), one case exhibited no IIN response postoperatively, which persisted at three months.
- One case in the open repair group also showed a negative EMG response on the non-operative side.
Conclusions:
- The PIRS technique for pediatric inguinal hernia repair appears to preserve ilioinguinal nerve function effectively.
- Conventional open repair may carry a risk of temporary ilioinguinal nerve dysfunction.
- Further investigation into nerve integrity following different hernia repair methods is warranted.
Purpose:
In this study, we aim to assess the alteration of IIN functions in children with inguinal hernias operated on using open or 'percutaneous internal ring suturing' (PIRS).
Methods:
This study was based on a prospective clinical trial of 60 pediatric patients. They were operated on using PIRS or conventional open hernia repair technique. Group 1 included 35 patients who were treated with PIRS technique. Group 2 included 22 patients who underwent a conventional open hernia repair. The ilioinguinal nerve stimuli in both the operational and non-operational areas were evaluated in patients with peripheral EMG for possible ilioinguinal nerve damage on the hernia side before the operation and to reevaluate ilioinguinal nerve function in the third postoperative week.
Result:
In Group 1, 19 cases underwent a preoperative EMG examination and in 35 cases, EMG examination was obtained postoperatively. Pre- and postoperative EMG results were normal in all cases in Group 1 on both the operational and non-operational sides. In Group 2, 15 preoperative and 25 postoperative EMG examinations were obtained. In Group 2, only one case with a right inguinal hernia who had normal preoperative EMG results showed no IIN response in a postoperative EMG evaluation obtained in the third postoperative week, with a normal left-side response. The EMG was repeated at the three-month postoperative third mark and revealed the same result. In a six-year-old female case, there was a negative EMG response on the non-operative side both pre- and postoperatively.
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