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[Laparoscopic phelps approach in children with inguinal hernia: a retrospective comparative study]
Yu A Kozlov1,2,3, S S Poloyan1, V Kapuller4
1Irkutsk State Regional Children's Clinical Hospital, Irkutsk, Russia.
Insights
The PHELPS procedure for pediatric inguinal hernia repair shows significantly lower recurrence rates and faster recovery than the SEAL method. This new technique offers improved outcomes for children undergoing hernia surgery.
Area of Science:
- Pediatric surgery
- Laparoscopic surgery
- Hernia repair
Background:
- Inguinal hernias are common in children, requiring effective surgical repair.
- Laparoscopic techniques offer minimally invasive options for hernia treatment.
- Comparing different laparoscopic methods is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the effectiveness of the PHELPS (peritoneal hernial ligation) procedure with the SEAL (sac encirclement and ligation) technique for laparoscopic inguinal hernia repair in children.
- To evaluate differences in recurrence rates, hydrocele incidence, and postoperative recovery between the two methods.
Main Methods:
- A comparative study involving 729 pediatric patients undergoing laparoscopic inguinal hernia repair.
- 255 patients received the PHELPS procedure, while 474 underwent the SEAL procedure.
- Analysis focused on recurrence, hydrocele incidence, surgery time, analgesia requirements, and hospital stay.
Main Results:
- The PHELPS procedure demonstrated significantly lower recurrence rates (0 vs. 17, p=0.001).
- Patients undergoing PHELPS experienced faster recovery, requiring less postoperative analgesia (p<0.001) and shorter hospital stays (p=0.010).
- No significant difference was observed in the incidence of postoperative hydrocele (p=0.097).
Conclusions:
- The PHELPS procedure is associated with a lower incidence of recurrence compared to the SEAL technique.
- PHELPS facilitates accelerated postoperative recovery in pediatric patients with inguinal hernias.
- The PHELPS method represents an effective advancement in laparoscopic inguinal hernia repair for children.
Objective:
To evaluate the effectiveness of a new method of inguinal hernia repair in children (PHELPS) first proposed by the authors compared to another laparoscopic method (SEAL).
Material And Methods:
The study demonstrated the results of laparoscopic treatment of 729 patients with inguinal hernias. Of these, 255 patients underwent PHELPS procedure. Other 474 patients underwent SEAL procedure. The difference between both methods is that hernial ligature is passed around the hernial sac in case of PHELPS. SEAL procedure implies capture of tissues of anterior abdominal wall (muscles and aponeurosis) into this knot. We analyzed whether this factor can lead to less incidence of recurrence and hydrocele.
Results:
Both groups were comparable by age, body weight and gender. Median of surgery time including correction of unilateral and bilateral hernia was similar (20.0 [10.0; 20.0] min versus 15.0 [15.0; 20.0] min; p=0.666). We found faster patient recovery after PHELPS procedure for inguinal hernia including much less doses of postoperative analgesia (1.0 [1.0; 1.0] versus 1.0 [1.0; 2.0]; p<0.001) and shorter hospital-stay (8.0 [8.0; 8.0] hours versus 8.0 [8.0; 9.0] hours; p=0.010). There were no significant differences in the incidence of postoperative hydrocele (0 versus 6; p=0.097). Nevertheless, recurrence rate differed significantly (0 versus 17; p=0.001).
Conclusion:
PHELPS procedure is characterized by lower incidence of recurrence and accelerated postoperative recovery compared to SEAL technique.
