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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Pediatric Inguinal Hernia Repair with Laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal
R Eurlings1, L E de Vreeze2, H Cakir3
1Department of Pediatric Surgery, MosaKids Children's Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Research Institute for Nutrition and Translational Research in Metabolism NUTRIM, Faculty of Health Medicine and Life Sciences FHML, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
Insights
Percutaneous Internal Ring Suturing (PIRS) offers shorter anesthesia times and lower recurrence rates for pediatric inguinal hernia repair (IHR) compared to laparoscopic intra-corporeal (LIHR) repair. Further studies are needed to confirm these findings in pediatric IHR.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Pediatric inguinal hernia repair (IHR) techniques are evolving, with laparoscopy gaining prominence over open surgery.
- Laparoscopic approaches include extra-peritoneal Percutaneous Internal Ring Suturing (PIRS) and intra-peritoneal laparoscopic intra-corporeal (LIHR) repair.
Purpose of the Study:
- To compare the outcomes of PIRS versus LIHR in pediatric patients.
- Key outcomes include recurrence rates and anesthesia times.
Main Methods:
- A prospective, non-randomized multicenter trial (PIHRL) included pediatric patients undergoing PIRS or LIHR.
- Data collected included post-operative complications, anesthesia times, cosmetic results, and quality of life via questionnaires at one-year follow-up.
Main Results:
- PIRS was associated with significantly shorter total anesthesia times (62.1 min vs. 84.7 min) and a lower recurrence rate (2% vs. 8%) compared to LIHR.
- One readmittance occurred in the LIHR group; one patient in the PIRS group experienced testicular atrophy.
Conclusions:
- PIRS is a safe and effective method for pediatric IHR, demonstrating advantages in anesthesia time and recurrence rates at one year.
- While re-intervention rates were not significantly different, longer follow-up and larger sample sizes are recommended to validate these findings.
Introduction:
Techniques for inguinal hernia repair (IHR) in children are continuously being improved. Open repair is increasingly giving way to laparoscopy, with two possible approaches for laparoscopy: extra-peritoneally (Percutaneous Internal Ring Suturing, PIRS) or intra-peritoneally (conventional laparoscopy with purse-string suture). The aim of this trial is to compare outcomes, e.g. recurrence and anesthesia times, of PIRS with intra-corporeal laparoscopy using a purse-string suture (LIHR).
Methods:
Subjects were prospectively, non-randomly included in the multicenter 'Pediatric Inguinal Hernia Repair with Laparoscopy' (PIHRL)-trial, to undergo surgery with PIRS or LIHR. The choice of method was based on shared-decision making between parents and surgeon. Follow-up was conducted one year after surgery. Data concerning post-operative complications and anesthesia times were collected. Parents were asked to complete two questionnaires (POSAS and TAPQoL/TACQoL) to assess cosmetic results and quality of life one year postoperatively.
Results:
177 subjects were included (PIRS n = 126, LIHR n = 51). There was a baseline difference in age between the groups from the different centers (1.4 ± 2.8 and 1.5 ± 2.5 years for PIRS and LIHR respectively in the MUMC + vs. 3.6 ± 3.5 years for PIRS in UCHW, p = <0.001). Total anesthesia time was significantly shorter with PIRS (62.1 ± 24.6min vs. 84.7 ± 21.7min, p = 0.001). Net surgical time was also shorter; however, this difference was not significant. One readmittance within 30 days occurred in the LIHR group due to subcutaneous hemorrhage of the surgical site. This resolved spontaneously without the need for intervention. There was a significant difference in recurrence rate (PIRS n = 2 (2 %), LIHR n = 4 (8 %), p = 0.038). One patient in the PIRS group suffered from testicular atrophy (p = 0.523) and five re-interventions were necessary after PIRS due to wound complications (p = 0.984).
Discussion:
PIRS is safe and effective for pediatric IHR, with shorter anesthesia times and a lower recurrence rate compared to LIHR at one-year follow-up. However, even though not significant, there were more re-interventions in the PIRS group necessary. Longer follow-up and a larger sample size are necessary to confirm these results.
