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Percutaneous Internal Ring Suturing (PIRS) - The Benefits of Laparoscopic Inguinal Hernia Repair
Przemysław Karol Wolak1,2, Agnieszka Strzelecka1, Aneta Piotrowska-Gall1,2
1Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland.
Insights
Laparoscopic inguinal hernia repair in children using the PIRS technique offers better hernia pathology assessment and shorter operative times. This method also shows a lower risk of contralateral hernia repair compared to open surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- The laparoscopic approach for pediatric inguinal hernia repair, specifically the Peritoneal Inlay Round Sac (PIRS) technique, is established but debated against open surgery.
- Concerns persist regarding the comparative benefits of laparoscopic versus open inguinal hernia repair in pediatric populations.
Purpose of the Study:
- To demonstrate the advantages of the laparoscopic PIRS technique over conventional open surgical methods for pediatric inguinal hernia repair.
- To compare outcomes between laparoscopic and open inguinal hernia repair in children.
Main Methods:
- A retrospective study compared 276 children (0-18 years) undergoing laparoscopic PIRS repair (2008-2016) with 274 children undergoing open repair.
- Laparoscopic procedures included assessment of internal inguinal ring pathology and contralateral patent processus vaginalis repair.
- Intraoperative findings documented hernia laterality and occurrence.
Main Results:
- Inguinal hernia recurrence was observed in 10 children (laparoscopic) versus 5 (open).
- The laparoscopic PIRS technique demonstrated a statistically shorter operative duration.
- A lower incidence of metachronous contralateral inguinal hernia was noted in the laparoscopic group (16 patients) compared to the open group.
Conclusions:
- Laparoscopic inguinal hernia repair using the PIRS technique provides superior assessment of hernia pathology.
- The laparoscopic approach is associated with reduced operative time.
- The PIRS technique offers a lower risk of contralateral hernia development or repair.
Introduction:
The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.
Purpose:
The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.
Patients And Methods:
We conducted a retrospective study that included children aged 0-18 treated using the PIRS technique in 2008-2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method.
Results:
The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia.
Conclusion:
The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.
