• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Subcutaneous endoscopic assisted ligation for inguinal hernia repairs in children – first large US experience and matched comparison with open hernia repair

Raghavendra Rao, MD, Michael Smith, Troy Markel, MD, Brian Gray, MD, Matthew Landman, MD. IU

Introduction: The subcutaneous endoscopic assisted ligation (SEAL) is a technique of pediatric laparoscopic hernia repair which has recently been incorporated by pediatric surgeons. This technical details of SEAL remain controversial. We present the outcomes of our large experience with this technique in comparison with open inguinal hernia repairs (OHR) in the pediatric population.

Methods: Demographic data, operative times, operative details and recurrence/complication rates were retrospectively reviewed for both the SEAL and OHR done between Jan-2017 to Sept-2018. Non-parametric tests were used to detect differences, and p<=0.05 was regarded as statistically significant. SEAL was performed as previously described in a rabbit model along with fulguration of sac[1]. Matching was done using propensity-score analysis.

Results: There were 213 OHRs and 90 SEAL procedures during the study period(Table).

For OHR, laparoscopic-look was performed in 23%. When successful, it revealed a contralateral PPV (patent processus-vaginalis) in 41% of cases, all of which were repaired. For the SEAL procedures, a contralateral PPV was found in 25%, all of which were repaired. There were no intraoperative complications for either technique.

OHRs had a recurrence rate of 0.4% (n=1) and 1.4% metachronous hernias (n=3). No patient had a lap look in the patients with metachronous hernias. SEAL repairs had 3 recurrences (3.3%,p=0.08). The post op complication rate for OHR was 2.8% [postoperative pain-2.3% and infection-0.4%]. There were 4 post-op complications with the SEAL technique (4.4%,p=0.6). Two of them were incisional infections, 1 a prominent retained suture and fourth excessive granulation at the umbilical trocar site.

90 SEAL procedures were matched to 90 OHRs using propensity-score analysis based on age, sex, follow-up time, hernia side, repair of contralateral-hernia and number of additional procedures. There were no differences in recurrence-rates (1 vs. 3 in OHR and SEAL respectively,p=0.6), complication-rates (1 vs. 4 in OHR and SEAL respectively,p=0.4) and OR-time [44.5 vs. 43 min in OHR and SEAL respectively,p=0.8].

Conclusions: The SEAL has similar OR-time and outcomes compared to OHR. Contralateral PPVs are very common and lead to metachronous hernias. SEAL has the advantage of more easily being able to detect contralateral PPVs and involves little cord dissection. Our study was limited by short follow-up. Greater experience should lead to better outcomes with SEAL.

  OHR SEAL
N 213 90
Isolated hernia repairs  162(76%) 55(61%)*
Age(median[IQR] days) 420[96-1936]

149[95-673] **

Sex(female%) 23 23
Additional Procedure(%) 24 39*
Follow-up(median [IQR] days) 29[1.0-189] 41.5[2.0-149.8]
OR-time(median[IQR] min) 39[28-63] 43[36-64.3]*

Index side of hernia(%)

Left

Right

Bilateral

 

31

51

18

 

38***

42

20

OR-time of Isolated hernia repairs (median[IQR] min) 35[26-49] 38[32-45]

*p<0.05.**p<0.005.***p<0.001

[1]Bruns NE et-al. Assessing the Adequacy of Absorbable Braided Suture for Laparoscopic High Ligation in Rabbits. J-Laparoendosc-Adv-Surg-Tech A.2017 Jul;27(7):733-736


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 98648

Program Number: ETP747

Presentation Session: Emerging Technology Poster Session (Non CME)

Presentation Type: Poster

View this Poster

11

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons