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Published on: June 4, 2020
Laparoscopic Pediatric Inguinal Hernia Repair: A Pilot Study in a Novel Guinea Pig Animal Model
Maria Carmen Mora1, Katharine R Bittner1, Kaitlyn E Wong1
11 Baystate Medical Center, Tufts University School of Medicine , Springfield, Massachusetts.
Insights
Dissecting and dividing the hernia sac with intracorporeal suture (DDIS) repair showed the best outcome in pediatric laparoscopic inguinal hernia repair. This technique best replicates open high ligation, improving healing and long-term success.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Pediatric laparoscopic inguinal hernia repair techniques vary.
- The extent of dissection at the internal ring and peritoneal division may influence repair outcomes.
- Long-term success hinges on effective healing post-repair.
Purpose of the Study:
- To compare the efficacy of different pediatric laparoscopic inguinal hernia repair techniques.
- To investigate the impact of internal ring dissection and peritoneal division on hernia repair healing.
- To identify the optimal laparoscopic approach for pediatric inguinal hernias.
Main Methods:
- Twenty Hartley guinea pigs underwent laparoscopic repair of natural open internal rings.
- Four surgical groups were established: intracorporeal suture repair (IS), dissection and division with intracorporeal suture (DDIS), subcutaneous endoscopically assisted ligation (SEAL), and Yueng (HOOK) repair.
- Repairs were assessed for integrity under pressure after a 6-week survival period, followed by suture removal to evaluate primary healing.
Main Results:
- No perioperative or postoperative complications were observed.
- Initial repair integrity: DDIS (10/10), SEAL (7/10), HOOK (7/10), IS (5/10).
- Repair integrity after suture removal: DDIS (10/10), HOOK (6/10), SEAL (5/10), IS (3/10), with DDIS showing statistically significant superiority (P=.01).
Conclusions:
- The DDIS technique, involving dissection and division of the sac with intracorporeal suture closure, demonstrated the best outcomes.
- This method effectively mimics traditional open high ligation.
- DDIS appears to be a superior technique for pediatric laparoscopic inguinal hernia repair, promoting better healing and success.
Background:
The purpose of this study was to compare different techniques for pediatric laparoscopic inguinal hernia repair. We hypothesize that the amount of dissection performed at the internal ring, with or without division of the peritoneum, will impact healing and thus long-term success of the repair.
Methods:
Following the Institution's Animal Care and Use Committee approval (708024-4), 20 Hartley guinea pigs underwent laparoscopic repair of their natural open internal rings. The guinea pigs were divided equally into four surgical groups: intracorporeal suture repair (IS), hernia dissection and division with intracorporeal suture (DDIS) repair, subcutaneous endoscopically assisted ligation (SEAL), and Yueng (HOOK) repair. After a 6-week survival period, a necropsy was performed. Repairs were evaluated and tested under pressures up to 30 mmHg. The suture was then removed to assess primary healing. Experimental data were analyzed using chi-square test.
Results:
There were no perioperative or postoperative complications. On initial evaluation, before suture removal, repair integrity was as follows: 5/10 IS, 10/10 DDIS, 7/10 SEAL, and 7/10 HOOK (P = .09). After suture removal, repair integrity was as follows: 3/10 IS, 10/10 DDIS, 5/10 SEAL, and 6/10 HOOK (P = .01).
Conclusion:
Overall, dissecting and dividing the sac with intracorporeal suture (DDIS) closure had the best outcome. This method appears to best replicate standard open high ligation.
