Year 2020 Vol. 28 No 4

PEDIATRIC SURGERY

M.A. AKSELROV 1, 2, S.M. PANTELEEV 1, A.V. STOLYAR 2, A.V. MARGARYAN 1, L.V. VIHAREVA 1

CLINICAL ANATOMY, TYPES OF OBLIQUE CONGENITAL INGUINAL HERNIAS AND FEATURES OF LAPAROSCOPIC HERNIORRHAPHY

Tyumen State Medical University 1,
Regional Clinical Hospital No2 2, Tyumen,
The Russian Federation

Objective. To optimize the operation of the extraperitoneal laparoscopic hernia repair in children by LASSO method, using the individual approach to carrying out a ligature depending on the anatomic type of the internal inguinal ring revealed on diagnostic laparoscopy.
Methods. Case histories (n=350) of children, from January, 2018 till May, 2019 were analyzed. There were 256 boys (73,14%) and 94 girls (26,86%). The age of children varied from 1 to 204 months. The operation method in all patients was the modified LASSO technique. The point was to use the original device for implementation of an extracorporeal ligation of the internal inguinal ring. Direct intraoperative data, such as the type of an inguinal ring and duration of operation were evaluated retrospectively.
Results. 545 inguinal rings on the right and on the left (taking into account uni- and bilateral inguinal hernia) were revealed. There are five types of rings: type 1 with slit-shaped opening, slit shaped; type 2a with a triangle shaped opening, triangular without peritoneal folds; type 2b triangular with peritoneal folds; type 3a oval without peritoneal folds; type 3b oval with peritoneal folds.
Type 3a was the most common type of ring (n=246). Type 2b (n=45) was the most rare. Implementation of the additional manipulator was carried out in 33 cases, in 22 of them the ring was of 3b type. In these 22 patients (24 inguinal rings) the reduction of mean duration of operation with 39,585,82 min. up to 205,77 min was obtained.
Conclusion. In laparoscopic treatment of inguinal hernia it is necessary to consider visual structure of an internal inguinal ring. There are five types of them in total: 1, 2a, 2b, 3a, 3b. When the internal inguinal ring (3b type) is revealed, it is necessary to introduce an additional trocar for the manipulator that facilitates extra peritoneal carrying out ligature during such operation and significantly reduces intervention duration.

Keywords: inguinal hernia, children, internal inguinal ring, inguinal region, laparoscopic hernia repair, pediatric surgery
p. 404-411 of the original issue
References
  1. Umesh AU. Some features of the treatment of inguinal hernias in children. Vestn AGIUV.2011;(2):6769. https://cyberleninka.ru/article/n/nekotorye-osobennosti-lecheniya-pahovyh-gryzh-u-detey (In Russ.)
  2. Takehara H, Ishibashi H, Satoh H, Fukuyama T, Iwata T, Tashiro S. Laparoscopic surgery for inguinal lesions of pediatric patients. In: Proceedings of the 7th World Congress of Endoscopic Surgery; Singapore, June 1-4, 2000. . 537-42.
  3. Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW 3rd. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A. 2014 Nov;24(11):811-18. doi: 10.1089/lap.2014.0194
  4. Draus JM, Kamel S, Seims A, Rescorla FJ. The role of laparoscopic evaluation to detect a contralateral defect at initial presentation for inguinal hernia repair. Am Surg. 2011 Nov;77(11):1463-66. doi: 10.1177/000313481107701134
  5. Shalaby R, Ismail M, Samaha A, Yehya A, Ibrahem R, Gouda S, Helal A, Alsamahy O. Laparoscopic inguinal hernia repair; experience with 874 children. J Pediatr Surg. 2014 Mar;49(3):460-64. doi: 10.1016/j.jpedsurg.2013.10.019
  6. Spakhi OV, Kopylov EP, Pakholchuk AP. Laparoskopicheskoe lechenie pakhovykh gryzh u detei. Meditsina Neotlozh Sostoianii. 2016;(1):84-87. http://www.mif-ua.com/archive/article/42349 (In Ukr)
  7. Kimura T, Yamauchi K, Ihara Y, Sawai T, Kosumi T, Yonekura T. Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique. Surg Today. 2012 Jan;42(1):100-3. doi: 10.1007/s00595-011-0020-9.
  8. Slalmakhovich VN. Reasonable approach to the surgical treatment of inguinal hernia in children. Sib Med Zhurn (Irkutsk) 2001;24(1):50-52. https://cyberleninka.ru/article/n/vybor-ratsionalnogo-sposoba-lecheniya-pahovyh-gryzh-u-detey (In Russ.)
  9. Kozlov YuA, Novozhilov VA, Rasputin AA, Kovalkov KA, Chubko DM, Baradieva PZh, Zvonkov DA, Timofeev AD, Ochirov ChB, Rasputina NV, Us GP, Kuznetsova NN. Treatment of inguinal hernias in children: review of laparoscopic techniques, or history of hooks and needles. Endoskop Khirurgiia. 2017;23(1):33-43. doi: 10.17116/endoskop201723133-43 (In Russ.)
  10. brahim MM. Two ports laparoscopic inguinal hernia repair in children. Minim Invasive Surg. 2015;2015:821680. Published online 2015 Feb 16. doi: 10.1155/2015/821680
  11. Helal AA. Laparoscopic single instrument closure of inguinal hernia in female children: A novel technique. J Pediatr Surg. 2015 Sep;50(9):1613-16. doi: 10.1016/j.jpedsurg.2015.05.003
  12. Li S, Li M, Wong KK, Liu L, Tam PK. Laparoscopically assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children. J Pediatr Surg. 2014 Dec;49(12):1818-20. doi: 10.1016/j.jpedsurg.2014.09.027
  13. Kozlov YuA, Novozhilov VA, Rasputin AA., Krasnov P.A. Technology of the single-incision laparoscopic surgery in the treatment of inguinal hernias in infants. Annaly Khirurgii . 2013;(6):31-37. https://elibrary.ru/item.asp?id=21474770 (In Russ.)
  14. Stolyar AV, Akselrov MA, Saharov SP. Congenital inguinal hernia - how to operate? Med Nauka i Obrazovanie Urala. 2016;17(2):111-15. https://elibrary.ru/item.asp?id=26283619 (In Russ.)
Address for correspondence:
625027 Russian Federation,
Tyumen region, Tyumen, Melnikayte str., 75, 2
Regional Clinical Hospital No2,
Surgical Unit No1
tel.: +7 92 22 67 52 92,
e-mail: stolyar.al@yandex.ru,
Stolyar Aleksandr V.
Information about the authors:
Akselrov Mikhail A., MD, Head of the Pediatric Surgery Department, Tyumen State Medical University, Head of the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6814-8894
Panteleev Sergei M., MD, Head of the Department of Human Anatomy, Topographic Anatomy and Operative Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0002-3006-6620
Stolyar Aleksandr V., Pediatric Surgeon, the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0002-0704-5418
Margaryan Artur V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0003-3497-8157
Vikhareva Larisa V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6864-4417
Contacts | ©Vitebsk State Medical University, 2007-2023