Purpose: Percutaneous internal ring suturing (PIRS) is a minimally invasive surgical technique of laparoscopic hernia repair in children under the control of a laparoscope placed in the umbilicus. The aim of this study was to evaluate the management and postoperative outcomes of PIRS for inguinal hernia repair in children.
Patients and methods: All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in the prospective cohort study. The following parameters were recorded: age, gender, body mass index, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, and intraoperative or postoperative complications and recurrences were recorded.
Results: A total number of 228 PIRS procedures were performed in 188 children [126 (67%) male individuals and 62 (33%) female individuals] with a median age of 4 [interquartile range (IQR), 2 to 6] years and a median follow-up of 46 (IQR, 38 to 52) months. From the total number of hernia repairs there were 99 (52.7%) right, 49 (26.1%) left, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR, 8 to 12) minutes for unilateral and 16 (IQR, 14 to 20) minutes for a bilateral repair. The median hospital stay was 24 (IQR, 8 to 24) hours. Regarding intraoperative complications, only 3 (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in 3 male children, hydrocele was recorded; in 2 cases, hydrocele resolved spontaneously and 1 required surgical treatment. No cases of other complications including testicular atrophy or recurrence were recorded.
Conclusion: In a hands of an experienced pediatric laparoscopic surgeon, PIRS is a simple, safe, and effective technique for inguinal hernia repair in children with excellent outcomes, cosmetic results, and a low incidence of complications and recurrence.
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