Ryohei Onishi, Yoshiyuki Kawakami, Hidenori Fujii, Makoto Yoshida, Hidemaro Yoshiba, Koji Doi, Toshiharu Aotake, Fumie Tanaka, Yuki Hirose. Department of Surgery, Japanese Red Cross Fukui Hospital, Fukui, Japan
Introduction: A Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) has become widespread as a safe and profitable operative procedure to treat pediatric inguinal hernia (IH). Recently, to reduce further operative invasiveness and to get better cosmetic results, single-incision LPEC has been developed.
Purpose: A single-incision LPEC for children was performed since July of 2014 at our hospital.To discuss the safety and usefulness of this procedure, we retrospectively investigated postoperative outcomes such as operative time, hospital stay and major complications.Moreover, we reviewed clinical records of patients who had surgical treatment with anterior approach (Potts method) and compared postoperative outcomes.
Operative procedure: Under general anesthesia, in supine position, we placed a 5 mm 30° laparoscope through 1.0 cm vertical trans-umbilical skin incision. A 2-3mm port for a grasping forceps was inserted through umbilicus. By using LPEC needle, hernia sac was closed extraperitoneally.
Results: From July of 2014 to April of 2016, 9 female cases of single-incision LPEC were performed at our hospital. Average age was 5.7 years old, range, 1.2- 7.5. Average operative time of unilateral and bilateral cases was 33 minutes, range, 27- 40, in 7 cases and 51 minutes, range, 46-55, in 2 cases in each. There were no serious complications associated with this procedure. In 2 bilateral cases, contra-lateral hernia was detected intra-operatively and repaired as well. Length of hospital stay was 3 days for all cases. No recurrence of hernia has been identified so far. On the other hands, from April of 2010 to April of 2015, Potts operation was performed in 28 female cases of inguinal hernia with an average age of 5.5 years old, range, 0.1- 12.6 years. Operative time of unilateral and bilateral cases was 37 minutes, range, 20- 61, in 26 cases and 70 minutes, range, 52- 88, in 2 cases in each.
Conclusions: Although we had a few single-incision LPEC cases, there were no operative complications and recurrence in the early postoperative period. Operative time in single-incision LPEC group was not significantly increased when compared to that in Potts operation group. We concluded that single-incision LPEC was less invasive and enough safe procedure that enabled us to perform contra-lateral exploration to treat incidental inguinal hernia without any additional operation. Thus some reports showed effectiveness of LPEC method in male child or in younger adult cases, we would expect single-incision LPEC is useful for them as well.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79745
Program Number: P596
Presentation Session: Poster (Non CME)
Presentation Type: Poster