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Major Complication Caused by Inguinal Hernia Recurrence After Percutaneous Internal Ring Suturing Procedure in a
Aleksandra I Sadecka1, Marek Wolski1
1Department of Pediatric Surgery, Medical University of Warsaw, Warsaw, POL.
Insights
Laparoscopic percutaneous internal ring suturing (PIRS) for pediatric inguinal hernias is safe in healthy children but lacks sufficient data for those with connective tissue disorders like Loeys-Dietz syndrome.
Area of Science:
- Pediatric Surgery
- Laparoscopic Surgery
- Hernia Repair
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Treatment options include open and laparoscopic approaches.
- Laparoscopic percutaneous internal ring suturing (PIRS) is a minimally invasive technique.
Observation:
- A 14-month-old boy with Loeys-Dietz syndrome underwent laparoscopic PIRS for inguinal hernia.
- The patient experienced hernia recurrence with intestinal strangulation two weeks post-operatively.
- A subsequent Lichtenstein open repair was successful.
Findings:
- The PIRS procedure has demonstrated safety, feasibility, and a low complication rate in healthy pediatric patients.
- Literature review indicates a lack of extensive studies on PIRS in patients with comorbidities, particularly connective tissue disorders.
- The case highlights potential risks of PIRS in patients with underlying conditions affecting tissue integrity.
Implications:
- Further research is needed to establish the safety and efficacy of PIRS in pediatric patients with connective tissue disorders.
- Careful patient selection is crucial for laparoscopic hernia repair, especially in those with comorbidities.
- The findings suggest caution when considering PIRS for inguinal hernias in children with syndromic conditions affecting connective tissue.
Abstract:
Inguinal hernia repair is one of the most frequently performed procedures in pediatric surgery. Treatment methods include classical open repair and laparoscopic approach. In this report we analyze a case of a 14-month-old boy with Loeys-Dietz syndrome treated for an inguinal hernia with laparoscopic percutaneous internal ring suturing (PIRS). Two weeks post-operatively the patient was diagnosed with a recurrence of the hernia complicated by an intestine strangulation. As a re-operation of the hernia, the Lichtenstein method was applied successfully. We analyzed the literature to determine the safety and possible contradictions of the PIRS procedure, with particular emphasis on patients with comorbidities such as connective tissue disorders. We conclude that in the PIRS procedure, despite its safety, feasibility and low complication rate in healthy patients, too few studies were made to draw similar conclusions for patients with comorbidities such as connective tissue disorders.
