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Abstract：
Introduction Inguinal hernia (IH) repair is among the most frequently performed surgical operations in children. While open herniorrhaphy has been the gold standard surgical method of choice, the popularity of laparoscopic repair has sharply risen over the past two decades. Although a wide range of literature on the use of laparoscopy for IH repair in children exists, data regarding neonates, an especially delicate group of children, is limited to only a few studies. This study aims to evaluate the surgical, anaesthetic, and follow-up data of term neonates undergoing percutaneous internal ring suturing (PIRS) for IH repair in order to determine if it is a viable option for this specific patient population. Materials and methods This single-centre retrospective cohort included all children who underwent PIRS for IH repair during an 86-month period between October 2015 and December 2022. Patients\' gender, gestational age at birth, age and weight at surgery, side of IH at diagnosis, per-operative findings (presence of contralateral patent processus vaginalis (CPPV)), surgical time, time under anaesthesia, follow-up time, and follow-up findings were collected from an electronic database and analysed. The primary outcome measures were surgical time, rate of recurrence, and presence of CPPV and the secondary outcome measures were anaesthesia time and the rate of complications. Results During the study period, 34 neonates (23 male and 11 female) underwent laparoscopic repair for IH using the PIRS technique. Average age and weight at surgery were 25.2 ± 3.2 (20-30) days and 3530.4 ± 293.6 (3012 - 3952) gm, respectively. IH was detected on the right side in 19 (55.9%), on the left side in 12 (35.3%), and bilaterally in three (8.8%) patients at their presenting physical examination. Nine patients (26.5%) were found to have CPPV perioperatively, which were all repaired simultaneously. The average surgical time was 20.3 ± 4.5 minutes for unilateral and 25.8 ± 4.0 minutes for bilateral IH repair (p<0.01). On the contrary, the average time under anaesthesia was 33.2 ± 4.5 minutes for unilateral and 33.5 ± 4.9 minutes for bilateral IH repair, but the difference was not statistically significant (p>0.05). No early postoperative complications were observed. The average follow-up time was 27.6 ± 14.4 (range: 3-49) months. Recurrence was seen in one patient (2.9%) and umbilical incision granuloma was observed in two (5.9%) patients. Conclusion Surgical times, anaesthesia times, complication rates, recurrence rates, and rate of CPPV in neonates undergoing PIRS are similar to those in older children and comparable to those of open herniorrhaphy and other laparoscopic techniques. Despite the suspicion that the rate of CPPV would be higher in neonates, we found that it is similar to that in older children. We conclude that PIRS is a viable option for the minimally invasive repair of IH in neonates.
摘要：
简介腹股沟疝（IH）修复是儿童最常用的外科手术之一。虽然开放式疝修补术一直是首选的黄金标准手术方法，在过去的二十年中，腹腔镜修复的普及程度急剧上升。尽管存在大量关于腹腔镜用于儿童IH修复的文献，有关新生儿的数据，一群特别脆弱的孩子，仅限于少数研究。这项研究旨在评估手术，麻醉,以及接受经皮内环缝合（PIRS）进行IH修复的足月新生儿的随访数据，以确定这是否是该特定患者人群的可行选择。材料和方法该单中心回顾性队列包括在2015年10月至2022年12月之间的86个月期间接受PIRS进行IH修复的所有儿童。患者性别，出生时的胎龄，手术时的年龄和体重，诊断时IH的一面，每次手术发现（存在对侧阴道突闭症（CPPV）），手术时间,麻醉下的时间，随访时间,从电子数据库中收集并分析了后续结果。主要结果指标是手术时间，复发率,CPPV的存在和次要结局指标是麻醉时间和并发症发生率。结果在研究期间，使用PIRS技术对34例新生儿（23例男性和11例女性）进行了腹腔镜IH修复。手术时的平均年龄和体重分别为25.2±3.2（20-30）天和3530.4±293.6（3012-3952）gm，分别。在19例（55.9%）的右侧检测到IH，在12个(35.3%)的左侧，三名(8.8%)患者在进行体检时的双侧情况。9例患者（26.5%）被发现有CPPV围手术期，都是同时修复的。单侧IH修复的平均手术时间为20.3±4.5分钟，双侧IH修复的平均手术时间为25.8±4.0分钟（p<0.01）。相反,单侧IH修复的平均麻醉时间为33.2±4.5分钟，双侧IH修复的平均麻醉时间为33.5±4.9分钟，但差异无统计学意义(p>0.05)。术后未出现早期并发症。随访时间3～49个月,平均27.6±14.4个月。1例（2.9％）复发，2例（5.9％）观察到脐切口肉芽肿。结论手术次数,麻醉次数,并发症发生率,复发率,接受PIRS的新生儿的CPPV率与年龄较大的儿童相似，与开放式疝修补术和其他腹腔镜技术相当。尽管怀疑新生儿的CPPV率会更高，我们发现这与年龄较大的孩子相似。我们得出的结论是，PIRS是新生儿IH微创修复的可行选择。
