A Study On Indirect Inguinal Hernia In Children Treated By Two-port Laparoscopic Technique Using Modified Hernia Needle

Objectives Analysis of the efficacy of a new modified two-port laparoscopic herniorrhaphy with Kirschner wire(TLHK)for children inguinal hernia in a large sample.Methods From June 2003 to December 2017,a total of 5,745 children with indirect inguinal hernia were hospitalized in pediatric surgery department of Jiangmen Central Hospital and Huangshi Maternity in Guangdong province and Children's Health Hospital of Edong Heal[thcare Group in Hubei province.In group A,4135 cases were treated with TLHK for hernia;in group B,1169 cases were treated with trans-umbilical single-incision laparoscopy(SIL),and in group C,215 cases were treated with traditional open surgers(OG).In group D,226 patients underwent double hook needle laparoscopic surgery.The operative time,hospital stay,intraoperative and postoperative complications were recorded and analyzed.Then the application of transumbilical double-hole laparoscopic with modified hernia needle in the incarcerated indirect inguinal hernia of newborns and infants was analyzed.Finally,the efficacy of the modified hernia needle and the ordinary hernia needle in the treatment of indirect inguinal hernia in children was compared.T test and chi-square test were used for data analysis.Result There was no difference in the sex ratio and the composition of unilateral and bilateral hernias between groups A,B,C and D.The patients were followed up for 1 month to 14 years.Compared with group B,both unilateral and bilateral operation time were significantly shortened(P<0.05),and the postoperative recurrence rate was significantly reduced(P<0.05).The damage of the iliac blood vessels,spennatic blood vessels and vas deferens during the operation occurred in no cases,neither in testicular atrophy and iatrogenic cryptorchidism.Compared with group C,both unilateral and bilateral operation time and hospitalization time were significantly shortened(P<0.05),and there was no significant difference in postoperative recurrence rate(P>0.05).There were no intraoperative complications such as iliac vessels,spermatic vessels,vasculars and iatrogenic cryptorchidism in either groups,and 2 cases of ipsilateral testicular atrophy in group C.Compared with group D,both unilateral and bilateral operation time were significantly shortened(P<0.05),postoperative recurrence rate was significantly reduced(P<0.05),no intraoperative damage to the vasculature and iliac vessels,and no iatrogenic cryptorchidism and testicular atrophy occurred postoperatively.Through further extraction of neonatal and infant cases for comparative analysis,it was found that there was no statistical difference between the groups in general data(P>0.05).The operation time in group A was significantly shorter than that in other groups(P<0.05).Except that the length of hospital stay in group A was shorter than that in group C(P<0.05),the recurrence rate of the same side in group A was lower than that in group B(P<0.05),the recurrence rate of the opposite side in group A was lower than that in group C(P<0.05),and the scrotal hematoma in group A was lower than that in group C(P<0.05).There was no statistical difference between the remaining observation indexes in group A and other groups(P>0.05).Conclusion After long-term large sample analysis,it was found that TLHK was proved to be safe and effective for non-emergency indirect inguinal hernia,infantile incarcerated indirect inguinal hernia,and neonatal indirect inguinal hernia,with shorter operation time and lower recurrence rate,which is expected to be widely used in clinical practice.