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Laparoscopic intra-abdominal patent processus vaginalis ligation in pediatric urology practice
Nima Baradaran1, Case M Wood1, Olugbemisola O McCoy1
1Department of Urology, Medical University of South Carolina, Charleston, SC, USA.
Insights
Laparoscopic intra-abdominal patent processus vaginalis ligation (LIPPL) is a safe and effective pediatric surgery for inguinal hernias and hydroceles. This minimally invasive technique shows a low recurrence rate and few complications.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Inguinal hernias and communicating hydroceles in children often result from a patent processus vaginalis (PPV).
- Traditional surgical approaches carry risks and may not allow for contralateral evaluation.
Purpose of the Study:
- To describe the laparoscopic intra-abdominal patent processus vaginalis ligation (LIPPL) procedure.
- To report the outcomes of LIPPL in pediatric urology patients.
Main Methods:
- A prospective study of children (<18 years) undergoing LIPPL between 2012 and 2014.
- The LIPPL technique involves percutaneous suture placement around the internal ring using a 5-mm umbilical camera.
Main Results:
- 142 patients with 197 PPV sites underwent LIPPL.
- No intraoperative complications occurred; low rates of recurrence (0%), surgical site infection (1%), and residual hydroceles (4%) were observed.
- Median follow-up was 14 months, with one suture granuloma reported.
Conclusions:
- LIPPL is a safe and effective minimally invasive treatment for pediatric patent processus vaginalis.
- The procedure offers a low complication rate, minimal recurrence, and allows for contralateral inguinal ring assessment.
Introduction And Objective:
Inguinal hernias and communicating hydroceles from a patent processus vaginalis (PPV) are common problems in children. This study provides a detailed description of the laparoscopic intra-abdominal patent processus vaginalis ligation (LIPPL) procedure along with its results in pediatric urology patients.
Methods:
Prospectively collected data were captured from children (<18 years) who underwent LIPPL from 2012 to 2014. Demographics as well as postoperative characteristics were reviewed and descriptively analyzed. LIPPL is performed using a 5-mm camera through the umbilicus. A loop of polypropylene suture is passed through a spinal needle percutaneously on one side of the internal ring. The needle is reinserted on the opposite side and the tail of the suture is fed through the original loop such that a purse-string is created around the peritoneum of the internal ring above the spermatic vessels and the vas; the suture is tied extracorporeally.
Results:
142 patients (3 female) were evaluated with 197 PPV sites repaired using LIPPL at median 24 (1-216) months of age. Median operating time was 35 (20-91) and 43 (27-85) minutes for unilateral and bilateral repairs, respectively. There were no intraoperative complications. During the 14 (1-34) months from surgery, there were no hernia recurrences, one surgical site infection, seven patients with residual small non-communicating hydroceles, and one patient who developed a suture granuloma.
Conclusions:
LIPPL is a safe and effective technique with minimal rate of hernia recurrence and few complications. LIPPL allows for easy repair of all sizes of PPV, with patients receiving the benefits of minimally invasive surgery including the ability to evaluate the contralateral inguinal ring.
