Laparoscopic Surgery for the Treatment of 170 Cases of Incarcerated Indirect Inguinal Hernia in Children:Medium and Long-term Efficacy
10.3969/j.issn.1009-6604.2024.11.002
- VernacularTitle:腹腔镜手术治疗儿童嵌顿斜疝170例中长期疗效
- Author:
Mao YE
1
;
Zhen CHEN
1
;
Shiying FAN
1
;
Jianji XU
1
;
Xuelai LIU
1
Author Information
1. 首都儿科研究所附属儿童医院普通外科,北京 100020
- Publication Type:Journal Article
- Keywords:
Laparoscopy;
Children;
Incarcerated hernia;
Indirect inguinal hernia
- From:
Chinese Journal of Minimally Invasive Surgery
2024;24(11):726-730
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the medium and long term curative effect of laparoscopic treatment of incarcerated indirect inguinal hernia and summarize the experience of laparoscopic treatment and the characteristics of incarcerated indirect inguinal hernia.Methods A retrospective summary was made on clinical data of 170 children with incarcerated hernia who underwent laparoscopic surgery between January 2016 to February 2024,including 109 boys and 61 girls.The patient's age ranged from 11 days to 11 years old,with a median of 8 months and 27 days.There were 88 cases of right incarcerated hernia and 82 cases of left incarcerated hernia.The incarcerating time (from onset to surgery) was 0.5-360 h,with a median time of 24 h.Results The surgical time was 11-191 min (mean,51.9±29.5 min).Conversion to open surgery was required in 20 cases,in which 14 cases were engaged through the inguinal region for reduction of incarcerated organ and removal of necrotic organ,and 6 cases were treated through umbilical incisions (4 cases of intestinal resection and anastomosis and 2 cases of ileal repair).Most of incarcerated organs among them were small intestine (ileum,84 cases),followed by the ovaries and fallopian tubes (53 cases),and ileocecal region (15 cases),as well as the greater momentum (11 cases).During the surgery,148 cases underwent manual reduction through laparoscopic surgery,14 cases underwent open inguinal region reduction,and 8 cases underwent self-reduction.There were 5 cases ( 2.9％) of small intestinal necrosis,3 cases (1.8％) of greater omentum necrosis,2 cases (1.2％) of small intestine perforation,2 cases (1.2％) of small intestine sarcoplasmic layer damage,2 cases (1.2％) of ovarian fallopian tube necrosis,and 1 case of colonic seromuscular layer damage.The intraoperative exploration revealed 109 cases ( 64.1％) of contralateral hidden hernia,7 cases ( 4.1％) of cryptorchidism,7 cases (4.1％) of umbilical hernia,1 case (0.6％) of Meckel' s diverticulum,and 1 case (0.6％) of ovarian cyst.Intestinal incarceration was seen in 106 cases,with 32 cases (30.2％) showing vomiting symptoms before surgery.Among them,all the 7 cases of necrosis or perforation of incarcerated intestinal tract had vomiting,2 out of 3 cases of damage to the seromuscular layer of incarcerated intestinal tract had vomiting,41.2％ cases (7/17) of blue purple incarcerated intestinal tract had vomiting,and 20.3％ cases (16/79) of incarcerated intestinal tract with fair blood supply had vomiting.The hospital stay was 1-11 d ( median,1 d).Follow-up period ranged from 4 months to 8 years and 5 months,with a median of 4 years and 11 months.Among them,51 cases were less than 3 years,38 cases were between 3 and 5 years,and 81 cases were over 5 years.Recurrence was seen in 2 cases (1.2％).One patient (0.6％) suffered from inguinal incision infection,and there were no complications such as intestinal obstruction or iatrogenic cryptorchidism.Conclusions Laparoscopic treatment of incarcerated indirect inguinal hernia has good medium and long term curative effect.During the surgery,it is necessary to consider the difficulty of hernia reduction and the blood supply of incarcerated organ for timely conversion to open surgery.Once a child with incarcerated hernia has vomiting symptoms before surgery,it indicates blood flow of incarcerated intestinal tract is affected,which requires a timely surgical treatment.
