Simultaneous minimally invasive repair of combined defects of the abdominal wall in children

Authors

DOI:

https://doi.org/10.15574/PS.2025.2(87).3338

Keywords:

combined abdominal wall defects, epigastric hernia, inguinal hernia, umbilical hernia, Percutaneous internal ring suturing (PIRS) technique, laparoscopy, pediatric surgery

Abstract

Nowadays, minimally invasive closure of abdominal wall defects is becoming more popular and is considered an alternative to open methods of their treatment.

Aim: to evaluate the effectiveness of simultaneous repair of combined abdominal wall defects in children using a minimally invasive technique.

Material and methods. A retrospective analysis of laparoscopic closure of combined abdominal wall defects was conducted in 13 children (11 boys and 2 girls), using a single-port technique in 10 cases and with the insertion of an additional working port in 3 others. The duration of surgery, the occurrence of intraoperative, early and late postoperative complications were determined.

Results. The average operation time was 30±3.54 min. In all patients, a multimodal anesthetic approach was used, and the treatment was performed within the day-case surgery. We did not observe any intraoperative or postoperative complications, both in the early and late postoperative period. The scar in the left lateral area is almost imperceptible, and the scar in the umbilical area seems to be a natural embryonic scar. Patients were observed for 1-2 years after surgery - no recurrence of hernias was detected.

Conclusion. Minimally invasive simultaneous repair of combined abdominal wall defects in children has the following advantages: excellent visual control, the ability to assess the contralateral inguinal ring and repair its defect when detected, reduced surgical and anesthetic time, ideal cosmetic and excellent economic results.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Author Biographies

O.S. Maksymenko, Poltava State Medical University

Limited Liability Company Medical Curatively-Diagnostic Center “MEDION”, Poltava, Ukraine

R.B. Lysenko, Poltava State Medical University

Limited Liability Company Medical Curatively-Diagnostic Center “MEDION”, Poltava, Ukraine

O.S. Osipov, Poltava State Medical University

Limited Liability Company Medical Curatively-Diagnostic Center “MEDION”, Poltava, Ukraine

References

Abdulhai SA, Glenn IC, Ponsky TA. (2017). Incarcerated Pediatric Hernias. Surg Clin North Am. 97(1): 129-145. https://doi.org/10.1016/j.suc.2016.08.010; PMid:27894423

Albanese CT, Rengal S, Bermudez D. (2006). A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias. J Pediatr Surg. 41(4): 859-862. https://doi.org/10.1016/j.jpedsurg.2005.12.033; PMid:16567211

Al-Taher RN, Khrais IA, Alma'aitah S, Al Saiad AA, Al-abboodi AA, Saleh OM et al. (2021). Is the open approach superior to the laparoscopic hernia repair in children? A retrospective comparative study. Annals of Medicine and Surgery. 71: 102889. https://doi.org/10.1016/j.amsu.2021.102889; PMid:34691442 PMCid:PMC8517708

Babsail AA, Abelson JS, Liska D, Muensterer OJ. (2014). Single-incision pediatric endosurgical epigastric hernia repair. Hernia. 18(3): 357-360. https://doi.org/10.1007/s10029-014-1235-7; PMid:24652585

Bhattacharjee SS, Daniel S, Das P, Hussain K, Kumar N, Singh M. (2020). Laparoscopic Paediatric Hernia Repair Using Tuohy Needle - Our Preliminary Experience of 100 Cases. Journal of Evolution of Medical and Dental Sciences. 9: 2903-2907. https://doi.org/10.14260/jemds/2020/635

Blonk L, Civil YA, Kaufmann R, Ket JCF, van der Velde S. (2019). A systematic review on surgical treatment of primary epigastric hernias. Hernia. 23(5): 847-857. https://doi.org/10.1007/s10029-019-02017-4; PMid:31422492 PMCid:PMC6838029

Coats RD, Helikson MA, Burd RS. (2000). Presentation and management of epigastric hernias in children. J Pediatr Surg. 35(12): 1754-1756. https://doi.org/10.1053/jpsu.2000.19242; PMid:11101730

Dvorakevych A, Pereiaslov A. (2014). Mini-invasive methods of surgical treatment of inguinal hernias. Paedriatric Surgery (Ukraine). (3-4): 54-57.

Dvorakevich A, Pereyaslov A. (2016). Minimally invasive treatment of recurrent inguinal hernias in children. Pediatric surgery. 20: 140-143.

Dvorakevych A, Pereyaslov A, Tkachyshyn Y. (2017). Modification of the traditional percutaneous internal inguinal ring suturing (PIRS method). Paedriatric Surgery (Ukraine). 2(55): 57-61. https://doi.org/10.15574/PS.2017.55.57

Gause CD, Casamassima MGS, Yang J, Hsiung G, Rhee D, Salazar JH et al. (2017). Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial. Pediatr Surg Int. 33(3): 367-376. https://doi.org/10.1007/s00383-016-4029-4; PMid:28025693

Gorbatyuk О. (2021). Incarcerated inguinal hernia in newborns and infants. Neonatology, Surgery and Perinatal Medicine. 11; 3(41): 41-45. https://doi.org/10.24061/2413-4260.XI.3.41.2021.6

Hall NJ, Choi W, Pierro A,Eaton S. (2012). Age-related probability of contralateral processus vaginalis patency in children with unilateral inguinal hernia. Pediatr Surg Int. 28(11): 1085-1088. https://doi.org/10.1007/s00383-012-3174-7; PMid:22983733

Kantor N, Travis N, Wayne C, Nasr A. (2019). Laparoscopic versus open inguinal hernia repair in children: which is the true gold-standard? A systematic review and meta-analysis. Pediatr Surg Int. 35(9): 1013-1026. https://doi.org/10.1007/s00383-019-04521-1; PMid:31292721

Liu J, Wu X, Xiu W, Hao X, Zhao J, Wei B et al. (2020). A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China. BMC Surgery. 20(1): 244. https://doi.org/10.1186/s12893-020-00912-7; PMid:33076895 PMCid:PMC7574473

Mollen KP, Kane TD. (2007). Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side. Curr Opin Pediatr. 19(3): 344-348. https://doi.org/10.1097/MOP.0b013e3281574597; PMid:17505198

Moreira-Pinto J, Correia-Pinto J. (2015). Scarless laparoscopic repair of epigastric hernia in children. Hernia. 19(4): 623-626. https://doi.org/10.1007/s10029-015-1369-2; PMid:25791626

Muensterer OJ, Gianicolo E. (2019). Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review. Int J Surg. 68: 11-19. https://doi.org/10.1016/j.ijsu.2019.06.001; PMid:31185313

Nakonechnyi A, Kuzyk A, Nakonechnyi R. (2016). Surgical correction of inguinal hernias in children using minimally invasive PIRS method. Paediatric surgery (Ukraine). (1-2): 78-81.

Öberg S, Andresen K,Rosenberg J. (2017). Etiology of Inguinal Hernias: A Comprehensive Review. Front Surg. 4: 52. https://doi.org/10.3389/fsurg.2017.00052; PMid:29018803 PMCid:PMC5614933

Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W. (2006). Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A. 16(5): 513-517. https://doi.org/10.1089/lap.2006.16.513; PMid:17004880

Pereyaslov A, Dvorakevych A. (2016). Uskladnennya khirurhichnoho likuvannya pakhvynnykh hryzh u ditey iz vykorystannyam vidkrytykh i maloinvaziynykh metodiv. Paediatric Surgery Ukraine. (3-4): 34-37.

Pogorelić Z, Stanić P,Bašković M. (2024). Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele. Children (Basel). 11(4). https://doi.org/10.3390/children11040437; PMid:38671654 PMCid:PMC11049082

Prytula V, Rybalchenko I. (2015). Diagnosis and treatment of inguinal-scrotal hernias in infants. Pathologia. (2): 48-51. https://doi.org/10.14739/2310-1237.2015.2.50809

Salgaonkar H, Shah R. (2023). Laparoscopic Pediatric Inguinal Hernia Repair. In D. Lomanto, W. T.-L. ChenM. B. Fuentes (Reds.), Mastering Endo-Laparoscopic and Thoracoscopic Surgery: ELSA Manual: 573-578. Singapore: Springer Nature Singapore. https://doi.org/10.1007/978-981-19-3755-2_77

Sözübir S, Ekingen G, Senel U, Kahraman H, Güvenç BH. (2006). A continuous debate on contralateral processus vaginalis: evaluation technique and approach to patency. Hernia. 10(1): 74-78. https://doi.org/10.1007/s10029-005-0047-1; PMid:16362231

Tatekawa Y, Yamanaka H,Hasegawa T. (2013). Single-port laparoscopic repair of an epigastric hernia using an epidural needle. Int J Surg Case Rep. 4(3): 262-264. https://doi.org/10.1016/j.ijscr.2012.12.007; PMid:23333850 PMCid:PMC3604676

Thomas DT, Göcmen KB, Tulgar S,Boga I. (2016). Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases. J Pediatr Surg. 51(8): 1330-1335. https://doi.org/10.1016/j.jpedsurg.2015.11.024; PMid:26777889

Wolak P, Strzelecka A, Piotrowska A, Wolak P, Piotrowska I, Dąbrowska K et al. (2022). Percutaneous Internal Ring Suturing (PIRS) - The Benefits of Laparoscopic Inguinal Hernia Repair. Therapeutics and Clinical Risk Management. 18: 135-144. https://doi.org/10.2147/TCRM.S348197; PMid:35237037 PMCid:PMC8882976

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Published

2025-06-28

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Section

Original articles. Abdominal surgery