Modification of the traditional percutaneous internal inguinal ring suturing (pirs method)

Abstract

Introduction. Surgical interventions in children concerning the inguinal hernia make up almost one third of all elective operations in the pediatric surgical clinics. Mini-invasive methods are also being used increasingly in the management of pediatric inguinal hernias. Percutaneous internal ring suturing (PIRS) that was introduced by professor D. Patkowski is one of the laparoscopic methods of the inguinal hernia treatment in pediatric population.
Objective – to evaluate the treatment outcomes of children with inguinal hernia applying the modified PIRS method («double» PIRS) and to compare them with the results of the traditional PIRS method.
Material and methods. The study was grounded on the surgical results in 142 children with the inguinal hernia, who received inpatient treatment during 2015-2016 years in Lviv Regional Children’s Clinical Hospital «OHMATDYT». According to the surgical technique all patients were divided into two groups: the main group included 78 pediatric patients, who underwent the «double» PIRS method, and the control group was consisted of 64 patients who were treated with the traditional PIRS method. The modified PIRS is represented by the formation of two loops that inserted through the medial and lateral hemispheres of internal ring. Besides, one of them serves as a guide for another.
Results. The mean age and weight were comparable for both groups and differences were not statistically significant. The mean operative time was 12.9±1.8 and 12.1±1.1 minutes for the conventional PIRS and the «double» PIRS respectively. The acute small bowel obstruction that required relaparoscopy was observed in one (1.6%) patient of the control group. In three children, including two (3.1%) of the control and one (1.3%) of the main group, the insignificant testicular edema was noted. The latter did not require additional management and spontaneously disappeared during one week after surgery. In the follow-up, the hernia recurrence was noted in one (1.6%) patient of the control group. In 3 (4.7%) patients who underwent the traditional PIRS and in 4 (5.1%) children after the «double» PIRS, the parents noted the slight swelling in the inguinal channel area during three months after surgery, which suggested an early recurrence of hernia, but the follow-up observation confirmed its complete resolution. No other complications were observed during the follow-up.
Conclusion. The «double» PIRS method had the number of advantages compared to the traditional one, such as the comparatively faster performance and formation of the loops around the internal inguinal ring that subsequently led to the shortening of operative time; the double suturation of loops promoted the tighter closure of internal ring, which minimized the risk of recurrence.