Muhammad Armughan, FCSP, MRCSI, MRCS, Eng1, Malik Muhammad Makki, MD2, Muhammad Tariq, FCPS, Surg, FCPS, uro1, Samia Yunas, MD3, Javed Iqbal, FRCS, FACS1. 1Bahawal Victoria Hospital, Bahawalpur, Pakistan, 2Sheikh Khalifa Medical City, Ajman, United Arab Emirates, 3Dr.Sulaiman Al Habib Medical Center,Dubai ,UAE
Objective: Introduction of MIS in pediatric age group has been proved feasible and safe.There is considerable evolution with introduction of a number of invovation in MIS pediatric inguinal hernia repair. High ligation of sac is the basic premise of surgical repair in pediatric inguinal hernias. There are different MIS techniques broadly grouped into intracorporeal or intracorporeal with extracorporeal component namely the suturing.Every techniques has its own complications. The main objective of our study was to focus on different anatomical pointers which can lead inadverent complications mainly bleeding and recurrence.
Methods & Procedures: Prospective review of 37 hernias (29 male and 2 female) (8 months – 13 years) performed laparoscopically between September 2015 and June 2016. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), contralateral inguinal hernia, complications, cosmesis and recurrence.
Results: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8-25) and 20.66 min (17 -27 min) respectively. One hernia repair still recurred(2.7%) even with all precautions and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. because of our techinique we could not find any adverent peroperative bleeding. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries
Conclusion: The results confirm safety, efficacy and cost effectiveness of laparoscopic inguinal hernia repair. During our per-operative analysis we focus to address the anatomical landmark to minimize future recurrence and peroperative surgical complications. We identified and named a point as J. Point at the tip of triangle of “Doom”. That is most important point to address peroperatively. There is high chance of recurrence if that point is not encircled well or inadequately circled because of fear of iliac vessels injury. We aslo concluded that ‘water dissection technique’ is effective techniques in un-experienced hand and in early stages of laparoscopic hernia repair to prevent inadvertent iliac vessels injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87977
Program Number: P011
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster