Clinical application of a Kirschner wire assisted double-hook water-injection hernia needle in complicated pediatric oblique inguinal hernia / 中华实用儿科临床杂志

Objective:To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods:The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results:Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88) years vs.(4.91±2.39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm 3vs.9 650.97(3 849.24, 17 539.51) mm 3]. The differences in the age at surgery and hernia sac volume were statistically significant ( t=-5.407, Z=-4.218; all P<0.001). There was no significant difference in body mass index between the 2 groups ( P>0.05). Taking hernias with sac volume >10 000 mm 3 as huge hernias, there were 70.18%(40/57 cases) and 47.25%(146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15, 20) min vs.15(15, 20) min] ( Z=-2.842, P<0.05). However, the operation time for huge oblique hernias with sac volume >10 000 mm 3 was not statistically significant between the 2 groups ( P>0.05). No recurrence in both groups was found during 6-16 months of follow-up. Conclusions:For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas de-ferens and spermatic cord vessels smoothly.As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar.With good feasibility and safety, it is applicable for clinical popularization.

El uso de neumoperitoneo preoperatorio progresivo en el tratamiento de hernia gigante de la pared abdominal / (The use of progressive preoperative pneumoperitoneum as treatment in giant abdominal wall hernia)

Resumen La cirugía para la corrección de las hernias ventrales gigantes, con pérdida de domicilio abdominal, representa un reto importante debido a la gran cantidad de comorbilidades potenciales. En esta patología se produce una migración de los órganos abdominales hacia el saco herniario; eventualmente, se atrofian los elementos de la pared y al tratar de retornarlos a su posición normal, se puede provocar múltiples efectos adversos en el paciente. Por eso, se debe realizar una cuidadosa planificación, preoperatoriamente. El uso de neumoperitoneo preoperatorio progresivo, permite una adaptación más adecuada desde el punto de vista fisiológico, tanto a nivel sistémico, como en la capacidad abdominal, para tolerar el retorno de los contenidos que han perdido su domicilio. Se presenta aquí el caso de una paciente femenina de 58 años, con una hernia ventral gigante con pérdida de domicilio abdominal, en cuyo manejo se utilizó la introducción preoperatoria progresiva de neumoperitoneo, descrita por primera vez por Goñi Moreno, en 1940.

Abstract Surgery for the correction of giant ventral hernias, with loss of abdominal domain, represents a major challenge due to the large number of potential comorbidities. In this pathology there is a migration of the abdominal organs to the hernia sac; eventually, the elements of the wall undergo atrophy and when trying to return the organs to their normal position, it can cause multiple adverse effects in the patient. Therefore, a careful planning must be carried out preoperatively. The use of progressive preoperative pneumoperitoneum, allows a more adequate adaptation from the physiological point of view, both at a systemic level, as in the abdominal capacity, to tolerate the return of contents that have lost their domain. We present here the case of a 58 year old female patient, with a giant ventral hernia with loss of abdominal domain, in whose management, the introduction of progressive preoperative pneumoperitoneum was used, described for the first time by Goñi Moreno, in 1940.

Reparación de hernia inguinoescrotal gigante con realización preoperatoria de neumoperitoneo / Repair of inguinoscrotal giant hernia with realization of preoperative pneumoperitoneum

Introducción: la hernia inguinoescrotal con "pérdida de derecho a domicilio" o también conocida como "gigante" es una entidad rara en nuestro medio, que generalmente se produce cuando una hernia inguinoescrotal común por determinados factores evoluciona a este tipo de hernia. Objetivo: determinar las ventajas del uso del neumoperitoneo preoperatorio en pacientes con hernias inguinoescrotales gigantes con pérdida de derecho a domicilio. Presentación del caso: se describe el manejo preoperatorio y quirúrgico de un paciente de 60 años, de piel blanca con hernia inguinoescrotal gigante "con pérdida del derecho a domicilio" mediante neumoperitoneo preoperatorio progresivo, con el fin de facilitar su reducción y evitar la tensión y la insuficiencia respiratoria que conllevaría. Para realizar el neumoperitoneo se utilizó el equipo de laparoscopía a través de un drenaje peritoneal colocado percutáneamente. Conclusiones: se realizó la intervención quirúrgica en la región inguinal izquierda por técnica de hernioplastia donde se encontró como contenido del saco herniario el epiplón mayor y el colon sigmoides.

Introduction: the inguinal-scrotal hernia with right loss to home or also well-known as "giant¨ is a strange entity in our mean that generally takes place when an inguinoscrotal common hernia for certain factors evolves to this hernia type. Objective: to determine the advantages of the use of the preoperative pneumoperitoneum in patient with inguinal-scrotal giant hernia with right loss to home. Case Presentation: the handling preoperative is described and surgical of a 60 year-old patient, white skin with inguinoscrotal giant hernia "with loss of the right to home" by means of preoperative progressive pneumoperitoneum with the purpose of to facilitate its reduction and to avoid the tension and the breathing inadequacy that it would bear. To carry out the pneumoperitoneum the laparoscopy team it was used through a drainage peritoneal percutaneus placed. Conclusions: he was carried out the surgical intervention in the region left inguinal for hernioplasty technique where it was as content of the hernia sack the biggest omentum and sigmoid colon.

Hanging giant inguinal hernia.

The giant inguinal hernia has now become rare. Better hygienic conditions and better hernioplasty techniques, carried out with local anesthesia; usually encourage patients to undergo surgical treatment of the hernia soon after diagnosis. A case of giant inguinoscrotal hernia is being reported. Problems arise in management for both the patient and the surgeons because of the rarity of reported cases.