extraperitoneal approach
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2022 ◽  
Vol 11 (2) ◽  
pp. 321
Author(s):  
Fu-Huan Huang ◽  
Po-Lung Cheng ◽  
Wen-Hsuan Hou ◽  
Yih-Cherng Duh

Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.


In Vivo ◽  
2021 ◽  
Vol 36 (1) ◽  
pp. 341-349
Author(s):  
MIKLOS ACS ◽  
HUBERT LEEBMANN ◽  
SEBASTIAN HÄUSLER ◽  
PHILIPP HARTER ◽  
POMPILIU PISO

2021 ◽  
Vol 8 ◽  
Author(s):  
Kunjie Zhang ◽  
Mingfang Qin ◽  
Guoqian Ding

Purpose: In this study, a novel surgical technique was developed for umbilical hernias, in which a laparoscopic cephalic approach plus a posterior sheath and an extraperitoneal approach was employed. The aim of this study was to determine the results of this new technique.Methods: From 2019 to 2020, 21 patients (81.8% men) with an umbilical hernia underwent a laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach, performed by two surgeons specializing in abdominal wall surgery, in two academic hospitals. Intraoperative and postoperative complications, operation time, blood loss, and hernia recurrence were assessed.Results: Twenty-one cases of umbilical hernia were successfully completed. The size of the hernia ring was 1.5–3 cm2, with an average of 2.39 ± 0.47 cm2. The operation time was 120–240 min (average, 177.3 ± 42.15 min), and the blood loss volume was 30–40 ml (average, 33.73 ± 3.55 ml). The mean follow-up period was 6 months, and there were no short-term complications and no cases of recurrence.Conclusion: A laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach is a safe alternative for the repair of an umbilical hernia. The intraoperative complication rate was low.


2021 ◽  
Vol 148 (2) ◽  
pp. 304-307
Author(s):  
Jae Hyeok Choi ◽  
Seung Yong Song ◽  
Hyung Seok Park ◽  
Choong Hyeon Kim ◽  
Jee Ye Kim ◽  
...  

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masahiro Fukuhara ◽  
Shun Onishi ◽  
Yusuke Yonemura ◽  
Tomoe Sato ◽  
Satoshi Tsutsumi ◽  
...  

Abstract Background A congenital prepubic sinus (CPS) is a rare congenital anomaly in which a duct remnant extends from the skin opening near the pubic symphysis to various parts and the lesions are mostly located in the preperitoneal space. The totally extraperitoneal (TEP) approach is an operational method that provides a good field of view for the preperitoneal space. We report the CPS through the pubic symphysis in which complete resection was achieved by a TEP approach. TEP approach was minimally invasive and achieved satisfactory cosmetic outcome. Case presentation We herein report the case of a 13-year-old boy with a fistula opening near the dorsal penis. He was admitted to our hospital due to fever and lower abdominal pain. Abdominal ultrasonography and computed tomography revealed an abscess inside a fistula lumen on the posterior surface of the rectus abdominis muscles in the midline of the lower abdomen. Under a diagnosis of CPS, which was located in the preperitoneal space, endoscopic resection was performed by a totally extraperitoneal approach. After making an umbilical incision, the rectus abdominis muscle was excised outward to expose the preperitoneal space. A single-port system was placed in the preperitoneal space. Three 5-mm-port trocars were inserted. As the preperitoneal cavity was expanded, a sinus connecting to the pubic symphysis was confirmed. The pubic symphysis did not connect with the bladder. Because the fistula was penetrated with the pubic symphysis, the remaining caudal fistula was removed from the body surface with a small spindle-shaped incision around the fistula opening. Finally, the sinus was completely resected, with confirmation from both the cranial side and dorsal side of the pubic symphysis. We were able to perform complete resection of the CPS with good visibility and without any peritoneal damage. There were no intraoperative complications. His postoperative course was uneventful during the 1-year follow-up. Conclusions The TEP approach may be feasible for the resection of a CPS and may allow safe and secure resection due to good visibility, even in pediatric patients.


2021 ◽  
Vol 27 ◽  
Author(s):  
Fubiao Zhou ◽  
Qian Wang ◽  
Liehua Liu ◽  
Shuanqiang Han ◽  
Weidong Jin ◽  
...  

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