背景:在过去的十年中,腹腔镜辅助小儿腹股沟疝修补术已逐渐被接受。然而,关于优化管理的共识仍然缺乏。这项研究的目的是比较改良的腹腔镜辅助单针腹腔镜经皮腹膜外闭合(LPEC)与开放式小儿疝/鞘膜积液修复的结果。
方法:我们回顾性回顾了2014年至2019年接受腹腔镜辅助单针LPEC和开放修补术(OR)治疗腹股沟疝的儿童的医疗资料。数据收集包括人口统计,疝气的侧向性,手术时间和随访时间。我们还回顾和分析了复发的证据,异时对侧腹股沟疝(MCIH)的发生率,和其他并发症。
结果:在我们的队列中,回顾性分析OR组961例患者和LPEC组1098例患者。对于双侧疝修补术,LPEC组的平均手术时间(22.3±3.5min)明显短于OR组(27.8±5.9min)(p<0.001)。术后复发率在OR组为1.3%(13/1035),在LPEC组为0.5%(6/1182)(p=0.056)。在OR组中,医源性隐睾的发生率高于LPEC组(0.4%vs.0%,p=0.013)。此外,MCIH的发生率在OR组为3.7%(33/887),在LPEC组为0.3%(3/1014)(p<0.01)。
结论:与开放式技术相比,腹腔镜辅助单针LPEC为小儿腹股沟疝/鞘膜积液修补术提供了一种简单有效的选择,低复发率,减少MCIH。
BACKGROUND: Laparoscopic-assisted repairs for pediatric inguinal hernia have gained gradual acceptance over the past decade. However, consensus about the optimal management is still lacking. The aim of this study is to compare outcomes of a modified laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) versus open repair of pediatric hernias/hydrocele in a single institution.
METHODS: We retrospectively reviewed the medical data of children who underwent laparoscope-assisted single-needle LPEC and open repair (OR) for inguinal hernia from 2014 to 2019. Data collection included demographics, laterality of hernia, surgical time and time to follow-up. We also reviewed and analyzed the evidence of recurrence, the incidence of metachronous contralateral inguinal hernia (MCIH), and other complications.
RESULTS: In our cohort, 961 patients in the OR group and 1098 patients in the LPEC group were analyzed retrospectively. Mean operative time was significantly shorter in the LPEC group (22.3 ± 3.5 min) than in the OR group (27.8 ± 5.9 min) for bilateral hernia repair (p < 0.001). Postoperative recurrence was 1.3% (13/1035) in the OR group and 0.5% (6/1182) in the LPEC group (p = 0.056). Iatrogenic cryptorchidism occurred statistically more frequently in the OR group than in the LPEC group (0.4% vs. 0%, p = 0.013). In addition, the incidence of MCIH was 3.7% (33/887) in the OR group and 0.3% (3/1014) in the LPEC group (p < 0.01).
CONCLUSIONS: Comparing to open technique, laparoscope-assisted single-needle LPEC provides a simple and effective option for pediatric inguinal hernia/hydrocele repair with excellent outcomes, a low incidence of recurrence, and reduced MCIH.