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Published on: November 12, 2021
Percutaneous Internal Ring Suturing for Inguinal Hernia Repair in Children: Retrospective Cohort of 714 Patients with
David Terence Thomas1, Sefa Sag2, Aybegum Kalyoncu Aycenk3
1Department of Pediatric Surgery, Maltepe University Faculty of Medicine, Istanbul 34857, Turkey.
Insights
Percutaneous internal ring suturing (PIRS) is a safe and effective method for pediatric inguinal hernia (IH) repair. Long-term follow-up shows low recurrence and complication rates, supporting PIRS as a viable surgical option.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic techniques have not surpassed open surgery for pediatric inguinal hernia (IH) repair.
- Concerns regarding long-term outcomes and recurrence rates hinder widespread adoption of minimally invasive IH repair in children.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of percutaneous internal ring suturing (PIRS) for pediatric IH repair.
- To present follow-up data on recurrence and complications in children undergoing PIRS.
Main Methods:
- Retrospective cohort study of 714 children undergoing PIRS for IH between 2013 and 2021.
- Minimum three-year follow-up, with parents contacted for long-term complication data, including recurrence.
- Data collected included age, IH side, contralateral patent processus vaginalis, surgical/anesthesia times, and complications.
Main Results:
- Average follow-up of 6.9 years for 714 patients.
- Low complication rate (0.84% of patients, 1.2% of procedures).
- Low recurrence rate (0.98% of patients, 0.78% of procedures).
Conclusions:
- PIRS demonstrates favorable long-term outcomes for pediatric IH repair.
- The technique is associated with low complication and recurrence rates, supporting its use.
- This study provides valuable data on PIRS efficacy in pediatric inguinal hernia repair.
Abstract:
Background and Objectives: Despite numerous described techniques, laparoscopy has yet to replace open surgery as the gold standard for inguinal hernia (IH) repair in children. This may be due to many variables, including the lack of long-term follow-up and concern for increased recurrence. In this study, we present our long-term follow-up data on children undergoing percutaneous internal ring suturing (PIRS) for IH repair. Materials and Methods: This retrospective cohort study included children who underwent PIRS for IH between May 2013 and May 2021 at three tertiary care institutions, with at least three years of follow-up. Age at surgery, side of IH, presence of contralateral patent processus vaginalis, surgical and anesthesia time, and complications were noted. Parents were contacted to enquire about long-term complications, such as recurrence. Results: Long-term follow-up (average 6.9 ± 2.3 years) was available for 714 patients. For unilateral and bilateral procedures, the average surgical time was 13.6 ± 5.4 and 19.9 ± 3.0, and the average anesthesia time was 27.7 ± 12.9 and 33.9 ± 14.1 min, respectively. Complications were seen in 0.84% of patients and 1.2% of procedures, and recurrence was observed in 0.98% of patients and 0.78% of procedures. Conclusions: Our study, with a nearly 7-year follow-up, provides substantial evidence that PIRS is a safe and effective technique for IH repair in children, with low recurrence and complication rates. Despite the study's retrospective nature and limited sample size, it contributes valuable data supporting the use of PIRS in pediatric IH repair.
