소아 복강경 탈장수술에서 기존의 고위결찰술에 탈장구멍인대봉합 추가를 통한 재발 위험도의 감소에 관한 연구
Adding iliopubic tract repair to high ligation reduces recurrence risk in pediatric
laparoscopic transabdominal inguinal hernia repair
Many laparoscopic methods are available for treating pediatric inguinal hernias.Recurrence after laparoscopic pediatric inguinal hernia repair (LPIHR) is one of the greatestconcerns for surgeons. The present study was performed to evaluate the effects of iliopubictract repair in LPIHR with respect to the recurrence rate, surgical outcomes, andcomplications.Methods: LPIHR was performed in 3386 pediatric patients aged <10 years from January2016 to June 2018. The patients were categorized into two groups according to the operativetechniques: high ligation alone (1736 patients) and additional iliopubic tract repair (1650patients). In high ligation surgery, the hernia sac was removed and the peritoneum was closed.In iliopubic tract repair surgery, iliopubic tract and transversalis fascia arch sutures wereadded.
Recurrence only occurred in the high ligation group; no patients in the iliopubic tractrepair group developed recurrence [0.35% (6/1736) vs. 0.00% (0/1650), respectively; p =0.014]. Other surgical outcomes and complications did not differ between the two groups. Sixpatients in the high ligation group developed recurrence: four infants aged <1 year and twochildren aged >1 year. The mean duration from the first operation to reoperation in these sixpatients was 11.8 months; five patients developed recurrence within 1 year after the initialoperation. All patients had a recurrent indirect hernia, and the location of the hernial defectswas on the medial side of the previous stitch. The logistic regression indicated that thedifference between the two groups affected the recurrence rate. This finding predicted thatiliopubic tract repair is associated with a lower recurrence rate than high ligation.
This study of transabdominal LPIHR indicates that iliopubic tract repair resultsin a small but significant decrease in the risk of recurrence.
laparoscopic pediatric inguinal hernia repair, iliopubic tract repair, recurrence