Liu Xuelai,Li Long,Li Suolin,et al.Application of vas deferens-external iliac vascular space during single-port laparoscopic percutaneous extraperitoneal closure using an inner grappler without hydrodissection in inguinal hernia with folded peritoneum around orifice in children[J].Journal of Clinical Pediatric Surgery,,19():426-431.[doi:10.3969/j.issn.1671-6353.2020.05.010]
Application of vas deferens-external iliac vascular space during single-port laparoscopic percutaneous extraperitoneal closure using an inner grappler without hydrodissection in inguinal hernia with folded peritoneum around orifice in children
- Keywords:
- Vas Deferens-external iliac Vascular Space; Free Hydrodissection; SPLPEC; Inner Grappler; Indirect hernia
- CLC:
- R726.9;R697;R656.2
- Abstract:
- Objective Folded peritoneum around orifice increases the difficulty during single-port laparoscopic percutaneous extraperitoneal internal ring closure (SPLPEC).The aim of this study was to explore the safety and feasibility of SPLPEC via previous separation and loosening deferens-external iliac vascular space using an inner grappler without hydrodissection for inguinal hernia in children. Methods Between November 2017 and December 2018,126 inguinal hernias children with folded peritoneum around orifice undertook SPLPEC via separation and loosening deferens-external iliac vascular space using an inner grappler without hydrodissection.Under single-port laparoscopic vision,an inner grappler with a non-absorbable suture was inserted at abdominal transverse striation into extraperitoneal space and fixed in an identical subcutaneous path.The inner grappler with suture passed through deferens-external iliac vascular space.Folded peritoneum around orifice was separated and loosened by enlarging this space and decreasing the attachment between vas deferens and retroperitoneum.After that,inclined surface of an inner grappler reached backward and passed through vas deferens without using hydrodissection technique.The same technique was applied for passing through spermatic vessel beyond hernia,followed by ligating and closing the orifice of inner hernia. Results A total of 162 sides of orifices (90 cases of unilateral hernia,n=90; bilateral hernia,n=36) were successfully completed using LPEC without hydrodissection via separating and loosening deferens-external iliac vascular space.Complete extroperitoeneal closure was performed without any assistances of extra instrument (n=17) and orifices were closed through retroperitoneal puncture (n=109).The average operative durations of unilateral and bilateral repairs were (17.5±3.5) and (23.2±2.2) min respectively.No intraoperative complications occurred and discharge was within 24 hours.During an average follow-up period of 6-18 months,there was no onset of wound infection,recurrence,iatrogenic cryptorchidism,testicular atrophy or granuloma.Conclusion Employing separating and loosening deferens-external iliac vascular space using an inner grappler without hydrodissection,SPLPEC is both safe and feasible for inguinal hernia children with folded peritoneum around orifice.
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收稿日期:2019-10-13。
基金项目:公益性行业科研专项（编号：201402007）；2018年度儿科学科协同发展中心"儿科专项"（编号：子课题XTZD20180301）
通讯作者:李龙,Email:lilong23@126.com;李索林,Email:lisuolin@263.net