RESULTS OF THE METHOD OF TOTAL EXTRAPERITONEAL ENDOSCOPIC ASSISTED HERNIA SAC LIGATION IN CHILDREN WITH INGUINAL HERNIA (PHELPS)

2021 ◽  
Vol 100 (4) ◽  
pp. 33-39
Author(s):  
Yu.A. Kozlov ◽  
◽  
P.A. Krasnov ◽  
S.S. Poloyan ◽  
A.N. Narkevich ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
New Technology ◽  
Demographic Data ◽  
Randomized Study ◽  
Total Duration ◽  
Operation Time ◽  
Laparoscopic Treatment ◽  
Hernia Sac ◽  
Hernial Sac ◽  
Total Extraperitoneal

The aim of the study was to evaluate the effectiveness of the new technology for laparoscopic treatment of inguinal hernia (IH) in children (PHELPS) in comparison with the popular extraperitoneal SEAL technique. Materials and methods of research: a retrospective comparative single-center non-randomized study was carried out. The analysis of the results of laparoscopic treatment of 680 patients with IH was performed, out of them 206 patients were operated on using the new PHELPS technique, in 474 cases the laparoscopic extraperitoneal SEAL technique was used. The gender composition of patients in the groups did not differ statistically significantly (m/f: 151/55–73.3%/26,7% versus 349/125–73.6%/26,4%, p=0,929). The median age of children in the PHELPS group was 169,5 [80,8; 261,3] days, in the SEAL group – 210,5 [78,0; 258,0] days (p=0,137). The difference between the new technique for treating IH in children consisted in the method of carrying out a hernial ligature around the neck of the hernial sac in such a way that the knot after percutaneous tying was located at the level of the peritoneum and did not include the tissues of the abdominal wall (aponeurosis and muscles). At the end of the study, a comparison of demographic data, intra- and postoperative results in the two groups of patients was made. Results: the median of the total duration of inguinal herniorrhaphy, including the operation time in patients with single and double sided hernia localization, confirmed statistically unchanged values of this indicator in the comparison groups (20,0 [15,0; 20,0] min versus 15,0 [15,0; 20,0] min, р=0,518). The study demonstrated a faster recovery of patients after using the PHELPS technique for the treatment of IH, with a statistically significantly lower number of doses of postoperative analgesia (1,0 [1,0; 1,0] versus 1,0 [1,0; 2,0 ], p<0,001) and a shorter hospital stay (8,0 [6,0; 8,0] hours versus 8,0 [8,0; 9,0] hours, p=0,031). Despite the fact that there were no statistically significant differences in the frequency of formation of dropsy of the testicle (0 (0,0%) versus 6 (1,3%), p=0,185), a statistically significantly better condition of patients was revealed as a result of the use of the innovative PHELPS technique, consisted in the absence of the return of symptoms of the disease – 0 (0,0%) versus 17 (3,6%), p=0,003. Conclusion: the new PHELPS method of treating IH in children allows to improve the quality of known extraperitoneal methods of treating the disease. The placement of a hernial ligature node at the level of the hernial sac neck, rather than over the aponeurosis, is expected to lead to a decrease in the number of relapses after surgery.

A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction

2019 ◽  
Vol 34 (4) ◽  
pp. 1882-1886
Author(s):  
Weiming Li ◽  
Yijun Li ◽  
Lili Ding ◽  
Qingwen Xu ◽  
Xiongzhi Chen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Randomized Study ◽  
Hernia Sac ◽  
Total Extraperitoneal

scholarly journals Total extraperitoneal approach in large inguino-scrotal hernias: an institutional approach

2016 ◽  
Vol 18 (3) ◽  
pp. 51 ◽  
Author(s):  
Tuhin Shah ◽  
S Shah ◽  
BR Joshi ◽  
RJ Karkee ◽  
RK Gupta
Keyword(s):  
Inguinal Hernia ◽  
Operating Time ◽  
Operation Time ◽  
Hernia Surgery ◽  
Recurrence Rates ◽  
Hernia Sac ◽  
Tep Repair ◽  
Inguinal Hernia Surgery ◽  
Total Extraperitoneal ◽  
The Mean

Introduction: Since 2 decades laparoscopichernia repair has gained key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia such as incarcerated, obstructed and inguino-scrotal is debatable. Cases of large inguino-scrotal raises objection to laparoscopic procedure because of anticipated problems and complications in dissecting extended hernia sac even though posterior approach is advocated as repair of choice for complicated cases. Here, we reviewed our series of patients undergoing TEP in a limited time frame.Method: Between March 2013 and June 2014, 50 consecutive patients underwent TEP repair for inguinoscrotal hernia. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative, postoperative complications and recurrence was recorded and analyzed using MS Excel.Results: 50 patients were recorded, 26 had unilateral and 24 had bilateral hernias. Mean age was 52 (22-72) years. The mean operation time was 70 (50-140) min. Bilateral repairs took 45% (18 min) longer than for unilateral repairs (52 + 12 min). Two (12.5%) patients required combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to asymptomatic seroma formation in 2 (12.5%) patients; 1 patient of combined open-TEP approach had wound infection, both treated conservatively. Mean follow up was 6.3 months; we recorded 2 recurrences (12.5%). The mean length of hospital stay was 1.8 days.Conclusion: We conclude that TEP can be safely employed for complicated inguinal hernias repair. Surgical experience in mandatory with tailored technique to reduce morbidity and achieve good clinical outcome with acceptable recurrence rates.

Laparoscopic cauterization of hernia sac in girls; the Burnia technique

2020 ◽  
Author(s):  
Sabriye Dayı
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Contralateral Side ◽  
Hernia Sac ◽  
Inguinal Hernias ◽  
Laparoscopic Techniques

INTRODUCTION: Inguinal hernia repair is one of the most common surgical procedures in pediatric surgery. In parallel with the advances in the field of medicine, various laparoscopic techniques have been developed in inguinal hernia repair. The Burnia technique is one of the latest published techniques and it is the cauterization of the inguinal hernia sac laparoscopically without using sutures in girls. The aim of this study is the investigation of the use of Burnia technique in clinical practice, and its postoperative outcomes. Any article concerning the use of this technique in Turkey has not been encountered. METHODS: The demographic features of patients, preoperative, peroperative, postoperative and follow-up results of 41 patients who had been operated with Burnia technique by a single surgeon within 2 years were reviewed retrospectively. Laparoscopically, the camera was first placed at an inclination of 30 degrees to the umbilical region using Hasson technique, and then, a single port was used for cauterization of the hernia sac. The Hernia sac was pulled into the abdominal cavity and cauterized. RESULTS: Burnia technique was applied to 62 inguinal hernia sacs in 41 girls. Their ages ranged from 1.5 to 16 years (median 36 months) with body weights ranging between 3.5 kg-40 kg (median 12 kg). Preoperatively 15 patients had right (37%), 19 patients left (46%), 7 patients bilateral inguinal hernias (17%). During surgery, 14 of the unilateral inguinal hernias were found to have a hernia sac on the contralateral side, and the rate of bilateral hernia increased to 51 percent. In one patient ovary was in the inguinal canal, and after its reduction, we proceeded with the operation Unexpectedly. in one patient, right ovarian torsion was detected which was detorsioned, and hernia surgery was performed in the same session. The duration of the operation was 5-35 min (median 15 min) for unilateral and 8-45 min (median 20 minutes) for bilateral hernias. None of these patients developed peroperative and postoperative complications. Follow-up time was minimum 10 months, and maximum 3 years. Recurrence was not detected. DISCUSSION AND CONCLUSION: Burnia technique seems to be effective and safe. The contralateral side and other intra-abdominal pathologies are explored. The cosmetic appearance is its another advantage. The operation time is very short due to the fact that only the hernia sac is cauterized. Comparison of this technique with other laparoscopic techniques is planned in the future study.

Reduced Postoperative Pain after Inguinal Hernia Repair with Absorbable String in Children

2014 ◽  
Vol 618 ◽  
pp. 401-404
Author(s):  
Chuan Zhang ◽  
Chun Yu Dong ◽  
Xue Song Zhao ◽  
Ji Xue Zhao ◽  
Dan Dang ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
High Ligation ◽  
Absorbable Suture ◽  
Intraoperative Blood Loss ◽  
Hernia Sac ◽  
The Mean

Object: To investigate effects of the high ligation of hernia sac with absorbable string for children with indirect inguinal hernia. Method: A retrospective analysis of 92 patients with inguinal hernia who underwent the high ligation of hernia sac was conducted in the present study, in which 20 cases underwent the high ligation of hernia sac with absorbable string while 72 cases treated with the high ligation of hernia sac with non-absorbable suture. The mean operation time, mean intraoperative blood loss and average postoperative hospital stay and postoperative pain rating were analyzed. Results: Though no statistical difference existed in the mean operation time, mean intraoperative blood loss, average postoperative hospital stay between the two groups (P>0.05). However, the postoperative pain in the high ligation of hernia sac with absorbable string group was significantly lower than that of the non-absorbable group. Conclusion: Compared with that of the high ligation of hernia sac with non-absorbable string, there is lower grade postoperative pain in the high ligation with absorbable suture.

scholarly journals Laparoscopic orchiopexy of palpable undescended testes - experience of a single tertiary institution with over 773 cases

2019 ◽  
Author(s):  
Jia You ◽  
Gang Li ◽  
Shuang Li ◽  
Haitao Chen
Keyword(s):  
Inguinal Hernia ◽  
Doppler Ultrasound ◽  
Vas Deferens ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Undescended Testes ◽  
Processus Vaginalis ◽  
Hernia Sac ◽  
Patent Processus Vaginalis ◽  
Laparoscopic Orchiopexy

Abstract Background To discuss the feasibility and superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended Testicles. Methods Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension. Results There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral occult hernia, and the hernia sac is ligated during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination. Conclusion Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. It could detect and treat contralateral patent processus vaginalis at the same time and avoid the occurrence of metachronous inguinal hernia.

scholarly journals Laparoscopic totally extra peritoneal (TEP) inguinal hernia repair: A series of 47 cases

2017 ◽  
Vol 5 (4) ◽  
pp. 120-123
Author(s):  
Suman Kumar Shrestha
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Inguinal Hernia Repair ◽  
College Teaching ◽  
Operation Time ◽  
Medical College ◽  
Inguinal Hernias ◽  
Total Extraperitoneal ◽  
The Mean

Background: Over the past years, several surgical techniques have been evolved, among which total extraperitoneal inguinal hernia repair is the laparoscopic technique which is more popular now.Objective: To evaluate the outcome of totally extra peritoneal laparoscopic hernioplasty in terms of operation time, hospital stay and complications.Methods: The prospectively designed descriptive study was carried out at Department of Surgery Unit III, Kathmandu Medical College Teaching Hospital from February 2014 to April 2015. Forty seven consecutive patients above 15 years of age underwent totally extra peritoneal repairs for inguinal hernias. The selection criteria were reducible primary or recurrent, unilateral, direct and indirect inguinal hernias. All the relevant details of each patient were noted subsequently and analyzed statistically using Statistical Program for Social Sciences (SPSS) version 15.Results: The mean age of patient was 49±2.5 years. The mean operation time was 65±5.3 minutes. There were no serious complications except four (8.5%) cases of groin seroma which resolved after single time aspiration. Three (6.3%) cases had developed recurrence, two (4.2%) had developed hydrocele in a median follow up period of 6±1.5 (range, 3-9months). The mean inpatient hospital stay was 1.7±0.2 (range, 1-2.4days).Conclusion: Total extra peritoneal hernioplasty is safe and feasible with acceptable complications and recurrence rates.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page: 120-123

scholarly journals Nonfixation of Mesh In Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: A Single-Center Experience

2021 ◽  
Author(s):  
Shigeyuki Nagata ◽  
Hiroyuki Orita ◽  
Daisuke Korenaga
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Mesh Fixation ◽  
Operation Time ◽  
Single Center Experience ◽  
Fixation Group ◽  
Total Extraperitoneal ◽  
Significant Difference ◽  
Large Orifice

Abstract Background: In terms of the need for mesh fixation in total extraperitoneal inguinal hernia repair (TEP), overseas data revealed no significant difference in the recurrence rate between patients with and without fixation. Moreover, there is no information available on this treatment outcome from Japan. We aimed to analyze the outcomes of nonfixation TEP with those of fixation at our institute.Methods: In May 2016, the nonfixation TEP technique was launched. The fixation group (165 patients) was compared to the nonfixation group (195 patients). Bilateral, large, and impaction cases were eliminated from the corrective comparison, and the outcomes for the fixation group (80 patients) and the non-fixation group (111 patients) were compared.Results: One patient in the nonfixation group experienced recurrence. It was a hernia case with a large orifice. In the fixation group, seroma was more prevalent. There was no recurrence and no significance in surgical complications in the correction comparison. The nonfixation group had a shorter operation time and stayed in the hospital for a shorter period after surgery.Conclusions: The nonfixation TEP was deemed adequate, at least for typical hernia cases.

scholarly journals Video-assisted percutaneous hernia sac suturing: a new technique of inguinal hernia repair in children

2020 ◽  
Vol 10 (4) ◽  
pp. 411-418
Author(s):  
Pavel M. Pavlushin ◽  
Alexey V. Gramzin ◽  
Nikolai V. Krivosheenko ◽  
Yuri Y. Koinov ◽  
Yuri V. Chikinev
Keyword(s):  
Inguinal Hernia ◽  
Minimally Invasive ◽  
Premature Infants ◽  
Operating Time ◽  
Minimal Invasive ◽  
Bilateral Hernia ◽  
Hernia Sac ◽  
Hernial Sac ◽  
Video Assisted ◽  
A New Technique

Background. Inguinal hernias are very important problem in pediatric surgery. It appears in 520 cases in every 1000 newborns, approximately 10 times prevalence in males. However, the incidence of inguinal hernia is bigger by 1.52 times in group of premature infants. Materials and methods. In prospective study, that was performed in 20192020, 90 pediatric patients diagnosed inguinal hernia were included. All patients had open herniotomy (Duhamel method), subcutaneous endoscopic-assisted ligation of inguinal hernia using Tuohy needle, or video-assisted percutaneous hernial sac suturing (VIPS). Results. The mean operating time in VIPS group was 13 13.46 min in patients with unilateral inguinal hernia and 20 6.12 min in patients with bilateral variant. In the 6-month follow-up period, any complications or recurrences were not observed. VIPS group included two extremely premature infant with uni- and bilateral inguinal hernia. Minimally invasive herniotomy was performed in 50 weeks post-conceptual age, with unremarkable postoperative period. A difference was found in the operating time between groups of minimally invasive herniotomy and group of Duhamel repair. No difference was found in the operating time of bilateral hernia between all groups. Conclusion. Considered all things, assuming that announced method of video-assisted percutaneous hernial sac ligation to be a perspective minimal invasive way of treatment for inguinal hernia in children is reasonable. However, for final conclusions, further study of this surgical technique, also in a cohort of premature infants, is required, with the possible organization of multicenter clinical trials.

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