Clinical application of laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac in pediatric giant inguinal hernias
10.3760/cma.j.cn101070-20241218-00853
- VernacularTitle:腹腔镜下髂耻束-腹横肌弓状下缘缝合紧缩内环法联合疝囊高位结扎术在儿童巨大疝中的临床应用
- Author:
Meng GUI
1
;
Lei ZHANG
1
;
Qingbao HE
1
;
Hao WANG
1
;
Lingling ZHANG
1
;
Hongjia HE
1
;
Kaisheng LI
1
Author Information
1. 山东大学附属儿童医院(济南市儿童医院)泌尿微创外科，济南 250000
- Publication Type:Journal Article
- Keywords:
Child;
Giant inguinal hernia;
Iliopubic tract;
Transversalis abdominis;
High ligation of the hernia sac
- From:
Chinese Journal of Applied Clinical Pediatrics
2025;40(9):680-684
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical efficacy of laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac in pediatric giant inguinal hernias.Methods:Randomized controlled study.Clinical data of 62 hernia sides in 61 children with inguinal hernia admitted to the Department of Minimally Invasive Urology, Children′s Hospital Affiliated to Shandong University from March 2021 to June 2024 were retrospectively analyzed.The maximum internal ring diameter, measured intraoperatively using an equal proportional indirect measurement technique, was >1.5 cm, defining a giant hernia.One child had bilateral giant hernias.Patients were divided into 2 groups based on surgical technique: the control group [29 sides (28 patients)] underwent traditional laparoscopic high ligation of the hernia sac; the study group [33 sides (33 patients)] underwent the laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac.Independent sample t-test, Mann-Whitney U test, and Fisher′s exact test were used to compare preoperative characteristics and postoperative complication rates between the two groups. Results:The study group had a median age of 38.00 (20.00, 107.50) months, 93.9%(31/33) were male, and median maximum internal ring diameter was 1.61(1.53, 1.82) cm.The control group had a median age of 32.50 (22.25, 65.00) months, 78.6%(22/28) were male, and median maximum internal ring diameter was 1.58 (1.54, 1.71) cm.There were no statistically significant differences in baseline characteristics between groups (all P>0.05). The operative time for the suture tightening/high ligation component was longer in the study group [(21.73±9.81) minutes] compared to the simple high ligation time in the control group [(16.69±7.36) minutes], with statistical significance ( t=-2.262, P=0.027). In terms of recurrence rate, there was a statistically significant difference between the study group(0) and the control group (4 cases, 13.80%) ( P=0.043). There was no statistical difference between the two groups in the incidence of other complications including intraoperative bleeding, groin area edema, or pain (all P>0.05). Conclusions:The laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac can effectively reduces postoperative recurrence when applied to the treatment of large hernias and is safe, making it a technique worthy of promotion.
