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Published on: November 12, 2021
Comparison of Open Repair and Laparoscopic Percutaneous Internal Ring Suturing Method in Repairing Inguinal Hernia in
Yusuf A Kara1, Beytullah Yağız1, Özlem Balcı1
1Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR.
Insights
Laparoscopic percutaneous internal ring suturing (PIRS) is a feasible alternative for pediatric inguinal hernias, offering shorter surgery times and detecting contralateral hernias. Open surgery had a lower recurrence rate but PIRS provides minimal scarring.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Inguinal indirect hernia is a common pediatric surgical condition.
- Evaluating surgical techniques for efficacy and outcomes is crucial.
Purpose of the Study:
- To compare laparoscopic percutaneous internal ring suturing (PIRS) with open inguinal hernia surgery in children.
- To assess outcomes including surgery duration, recurrence, and complications.
Main Methods:
- A comparative study of pediatric patients undergoing open or laparoscopic PIRS for indirect inguinal hernias.
- Data collected included patient demographics, hernia side, operative technique, surgery duration, recurrence, complications, and follow-up.
- 405 patients with 488 hernias were analyzed.
Main Results:
- Laparoscopic PIRS demonstrated significantly shorter surgery times for both unilateral and bilateral hernias compared to open surgery.
- Contralateral hernias were identified in 23.4% of PIRS patients.
- Recurrence rates were 3% for PIRS and 0.5% for open surgery; complication rates were comparable.
Conclusions:
- Laparoscopic PIRS is a feasible and advantageous technique for pediatric inguinal hernias, offering benefits like contralateral hernia detection and minimal scarring.
- PIRS preserves the spermatic cord and is an effective alternative to open surgery, especially for hernias with communicating hydrocele.
Abstract:
Introduction An inguinal indirect hernia is one of the most frequent surgical conditions in children. In this study the experience with laparoscopic percutaneous internal ring suturing (PIRS) and open inguinal hernia surgery and their relations evaluated. Methods All children over 90 days of age and without having prior inguinal region surgery with a diagnosis of indirect inguinal hernia underwent surgical repair with open or laparoscopic PIRS technique. Patients' gender, age at surgery, inguinal hernias side, surgery duration, recurrence, complications, and follow-ups were collected. Results A total of 488 inguinal hernias of 405 patients were repaired. The diagnoses were unilateral inguinal hernia in 360 (88.9%) and it was bilateral in 33 (8.1%) patients. The operative technique was laparoscopic PIRS for 227 and open inguinal hernia surgery for 178 patients. In the PIRS group, a contralateral hernia was found in 48 of 205 children (23.4%). The surgery times were 23.3 (PIRS) and 33.7 (open) min for unilateral and 28 (PIRS) and 53.1 (open) min on average for bilateral inguinal hernia surgery. Mean follow-up was 30.4 months for PIRS and 24.4 months for open technique. Recurrence was observed in seven (3%) patients in PIRS and one (0.5%) in the open group and postoperative complications in three (1.3%) in PIRS and four (2.2%) in the open group. Conclusion PIRS method has the advantage to evaluate contralateral hernia at the same session, minimal scar related to surgery, and preserve the spermatic cord from manipulation. PIRS is an alternative feasible method and easy to perform to repair the inguinal hernia with/without communicating hydrocele in children.
