Лапароскопски асистирана техника на перкутано затворање на внатрешниот ингвинален прстен наспроти отворена конвенционална техника за третман на индиректни ингвинални хернии кај деца

Abstract

Introduction: Inguinal hernia is the most common reason for consultation with a pediatric surgeon, and it is one of the most frequently performed interventions in pediatric surgery. The incidence of indirect inguinal hernias in infants and children ranges from 0.8-4.4%. Hernias are 10 times more common in male as opposed to female children, and more common in premature babies (13% prevalence). Inguinal hernia treatment is operative, for which there are more surgical techniques for open and minimally invasive laparoscopic techniques. Aim: The aim of this research was to compare the open conventional technique (OH) versus the laparoscopically-assisted technique of percutaneous closure of the internal inguinal ring (PIRS technique) in children aged between 1 and 14 years, and to indicate any differences and causes of the effect. Material and methods: This was a prospective clinical study conducted at the University Clinic of Pediatric Surgery in Skopje in the period 2015-2017, where 98 pediatric patients were evaluated; female children aged between 1 and 14 years, with clinically diagnosed indirect inguinal hernia. Patients from the examined group were treated with PIRS technique, and patients in the control group were treated with OH. The data of interest for the research were: (a) demographic characteristics; (b) registered anamnestic data; (c) diagnostic procedures; (d) outcome of surgical treatment; (e) postoperative evaluation; and (f) patient satisfaction from the method. Results: There were 49 (50%) v.s. 49 (50%) patients in the groups treated with PIRS technique/OH. The mean age of patients treated with PIRS technique / OH was 5.3 ± 2.7 v.s. 5.9 ± 3 years. Regarding the location of hernia in the PIRS technique as opposed to OH, 29 (59.2%) v.s. 27 (55.1%) were right-sided; - 19 (38.8%) v.s. 18 (36.7%) were left-sided, and 1 (2.0%) v.s. 4 (8.2%) were two-sided. The presence of hidden hernia in the PIRS group was found in 16 (32.7%) subjects, and it was treated during the intervention itself. The average duration of intervention in one-sided PIRS versus OH was 29.5 ± 6.8 v.s. 44 ± 4.2 minutes (p = 0.0001), while for the two-sided it was 43.6 ± 7.2 v.s. 97 ± 8 minutes. There were no reported intraoperative complications in any of the groups. Regarding the analysis of postoperative pain analyzed with a VAS scale from 0 to 10, the average grade was 0.3 ± 0.5 v.s. 2.5 ± 1.6 for PIRS versus OH technique(p = 0.00001). In the examined group treated with PIRS technique with/without analgesic therapy were 45 (91.8%) v.s. 4 (8.2%) patients, while in the control group the ratio was 12 (24.5%) v.s. 37 (75.5%). In the examined group, 4 patients received only one dose of analgesics, while in the control group 15 (40.5%) received two doses of analgesics, 11 (29.7%) received one dose, 9 (24.3%) received three doses, and 2 (5.4%) received four doses. The average length of hospitalization was 14.1 ± 3.1 v.s. 44 ± 4.2 hours (p = 0.00001). A significant difference was found in relation to the sample analysis by the size of the mark between PIRS and OH, which was: right 2.2 ± 0.4 v.s. 38.2 ± 4.1 mm, left 4.1 ± 6.8 v.s. 38.4 ± 4.8 mm. Conclusion: The PIRS technique for the treatment of inguinal hernias in childhood is a safe and effective method. By mastering the learning curve this technique can be used as a method of choice in the treatment of an inguinal hernia in the near future.