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Abstract：
OBJECTIVE: This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC).
METHODS: From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2-5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence.
RESULTS: Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0-38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament.
CONCLUSIONS: The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.
METHODS: From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2-5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence.
RESULTS: Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0-38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament.
CONCLUSIONS: The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.
摘要：
目的：探讨单孔腹腔镜经皮腹膜外封闭术(SPLPEC)后小儿腹股沟疝(PIH)复发的原因。
方法：2015年1月至2020年12月，回顾性分析3480例接受SPLPEC治疗的PIHs患儿的临床资料。包括2015年1月至2016年12月期间使用自制单钩疝针进行SPLPEC的644名儿童,以及2017年1月至2020年12月期间使用双钩疝针进行SPLPEC并进行水解剖的2836名儿童.在2-5年的随访中，有39例复发（包括交通性鞘膜积液）。记录了重做腹腔镜检查的结果，并与第一次手术的修订视频相关联，以分析复发的原因。
结果：33名男性和6名女性复发，8例患者有单侧交通性鞘膜积液。中位复发时间为7.1个月（0-38）。单钩组20例(3.11%),双钩组19例(0.67%)。根据腹腔镜检查的结果，复发很可能是由多种因素引起的，包括张力不均的结扎（10例），腹膜缺失部分（14例），松散结扎（8例），打结（5例），和结反应（2例）。所有接受重复SPLPEC的儿童均通过双结扎或用脐内侧韧带加固来治愈。
结论：结扎不当是复发的主要原因。无张力和完全的PIH结扎对手术的成功至关重要，这需要避免腹膜跳跃区域以及皮下和肌肉组织。重做腹腔镜手术适用于复发性腹股沟疝（RIH）的治疗。对于巨大的疝气，可能需要直接结扎合并脐内侧韧带(DIRIM)的内环.
方法：2015年1月至2020年12月，回顾性分析3480例接受SPLPEC治疗的PIHs患儿的临床资料。包括2015年1月至2016年12月期间使用自制单钩疝针进行SPLPEC的644名儿童,以及2017年1月至2020年12月期间使用双钩疝针进行SPLPEC并进行水解剖的2836名儿童.在2-5年的随访中，有39例复发（包括交通性鞘膜积液）。记录了重做腹腔镜检查的结果，并与第一次手术的修订视频相关联，以分析复发的原因。
结果：33名男性和6名女性复发，8例患者有单侧交通性鞘膜积液。中位复发时间为7.1个月（0-38）。单钩组20例(3.11%),双钩组19例(0.67%)。根据腹腔镜检查的结果，复发很可能是由多种因素引起的，包括张力不均的结扎（10例），腹膜缺失部分（14例），松散结扎（8例），打结（5例），和结反应（2例）。所有接受重复SPLPEC的儿童均通过双结扎或用脐内侧韧带加固来治愈。
结论：结扎不当是复发的主要原因。无张力和完全的PIH结扎对手术的成功至关重要，这需要避免腹膜跳跃区域以及皮下和肌肉组织。重做腹腔镜手术适用于复发性腹股沟疝（RIH）的治疗。对于巨大的疝气，可能需要直接结扎合并脐内侧韧带(DIRIM)的内环.
