PDF(Pubmed)
Abstract：
BACKGROUND: Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV).
METHODS: The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR).
RESULTS: A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups.
CONCLUSIONS: PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.
METHODS: The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR).
RESULTS: A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups.
CONCLUSIONS: PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.
摘要：
背景：尽管腹腔镜手术已成为许多手术治疗的标准方法，但许多研究仍在争论腹腔镜手术在疝或鞘膜积液治疗方面是否比开放手术具有显著优势。本研究旨在评估腹腔镜经皮内环缝合（PIRS）和开放结扎术之间小儿交通性鞘膜积液的治疗效果。
方法：对2019年1月1日至2024年1月1日期间因交通性鞘膜积液接受手术的儿科患者的病历进行回顾性分析。该研究的主要目的是研究腹腔镜和开放手术方法之间儿童交通性鞘膜积液的治疗结果（并发症和复发率）。研究的次要结果是手术和麻醉的持续时间，住院时间（LOS），再次入院（ReAd）和计划外返回手术室（uROR）的频率。
结果：共有198名儿童接受了交通性鞘膜积液手术（205名修复，由于7例为双侧病例)并纳入研究。其中,87名儿童接受了PIRS，其余111例进行了PPV的开放性结扎。在任何研究组中均未观察到鞘膜积液的复发。两组中有2例术中并发症（上腹部静脉损伤）（2.3％vs.1.8%,p>0.999)。与PIRS组（n=2，2.3％）相比，开放组（n=7，6.3％）的术后并发症数量略高（p=0.190）。手术的中位持续时间(15分钟(IQR10,17)与21分钟（IQR15，25）；p<0.001）和麻醉（30分钟（IQR25，40）与与PPV的开放结扎相比，PIRS组的40分钟（IQR35，40）；p<0.001）显着降低。此外,与开放PPV组相比，PIRS组的LOS中位数明显较短（9h（IQR8，12）与24h(IQR12，24；p<0.001)。在任何研究组中均未观察到ReAd和uROR病例。
结论：PIRS是一种安全有效的腹腔镜技术，可用于治疗儿童交通性鞘膜积液。PIRS显示出优异的结果，并发症和复发的发生率低，与传统的开腹手术相媲美。
方法：对2019年1月1日至2024年1月1日期间因交通性鞘膜积液接受手术的儿科患者的病历进行回顾性分析。该研究的主要目的是研究腹腔镜和开放手术方法之间儿童交通性鞘膜积液的治疗结果（并发症和复发率）。研究的次要结果是手术和麻醉的持续时间，住院时间（LOS），再次入院（ReAd）和计划外返回手术室（uROR）的频率。
结果：共有198名儿童接受了交通性鞘膜积液手术（205名修复，由于7例为双侧病例)并纳入研究。其中,87名儿童接受了PIRS，其余111例进行了PPV的开放性结扎。在任何研究组中均未观察到鞘膜积液的复发。两组中有2例术中并发症（上腹部静脉损伤）（2.3％vs.1.8%,p>0.999)。与PIRS组（n=2，2.3％）相比，开放组（n=7，6.3％）的术后并发症数量略高（p=0.190）。手术的中位持续时间(15分钟(IQR10,17)与21分钟（IQR15，25）；p<0.001）和麻醉（30分钟（IQR25，40）与与PPV的开放结扎相比，PIRS组的40分钟（IQR35，40）；p<0.001）显着降低。此外,与开放PPV组相比，PIRS组的LOS中位数明显较短（9h（IQR8，12）与24h(IQR12，24；p<0.001)。在任何研究组中均未观察到ReAd和uROR病例。
结论：PIRS是一种安全有效的腹腔镜技术，可用于治疗儿童交通性鞘膜积液。PIRS显示出优异的结果，并发症和复发的发生率低，与传统的开腹手术相媲美。
