Technical refinements of pediatric laparoscopic percutaneous extraperitoneal closure for adult indirect inguinal hernia.

IF 2.7 2区医学 Q1 SURGERY

Hernia Pub Date : 2026-08-11 DOI:10.1007/s10029-026-03816-2

Shoko Kato, Takuya Saito, Kenitiro Kaneko, Remi Kondo, Nozomi Matsushita, Yasuyuki Fukami, Tsuyoshi Sano

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引用次数: 0

Abstract

Purpose: Laparoscopic percutaneous extraperitoneal closure (LPEC) is an established procedure for pediatric inguinal hernia repair. In adults, however, its application is technically more demanding because of a thicker abdominal wall, greater tissue resistance, and a deeper ligation plane. Based on our standardized pediatric LPEC technique, we describe technical refinements for adult indirect inguinal hernias and examine an important cautionary finding related to patient selection.

Methods: Among adults with suspected indirect inguinal hernia treated between 2023 and 2025, 20 patients who underwent LPEC were evaluated. For adult cases, we incorporated several technical refinements, including double ligation, puncture-site enlargement, tension reduction during ligation, and needle-route straightening.

Results: The procedure was completed in selected adults, including those with a high body mass index and greater abdominal wall thickness. Recurrence occurred in two patients, both of whom had preoperative bowel protrusion. This finding suggests that bowel protrusion should be regarded as an important cautionary feature when considering the indication for adult LPEC.

Conclusion: Standardized pediatric LPEC may be adapted for selected adults when appropriate technical refinements are applied. However, cases with preoperative bowel protrusion require particularly careful judgment when determining indication.

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儿童腹腔镜下经皮腹腔外缝合成人腹股沟斜疝的技术改进。

目的：腹腔镜经皮腹膜外缝合术（LPEC）是儿科腹股沟疝修补术的一种成熟方法。然而，在成人中，由于腹壁更厚，组织阻力更大，结扎面更深，因此其应用在技术上要求更高。基于我们标准化的儿科LPEC技术，我们描述了成人腹股沟间接疝的技术改进，并检查了与患者选择相关的重要警示发现。方法：在2023年至2025年间治疗的疑似腹股沟间接疝的成年人中，对20例接受LPEC的患者进行了评估。对于成人病例，我们采用了几种技术改进，包括双重结扎、穿刺部位扩大、结扎时张力降低和针路矫直。结果：该手术在选定的成年人中完成，包括那些身体质量指数高和腹壁厚度大的成年人。2例患者复发，术前均有肠突出。这一发现表明，在考虑成人LPEC的适应症时，肠突出应被视为一个重要的警示特征。结论：通过适当的技术改进，标准化的儿童LPEC可以适用于特定的成人。然而，术前肠突出的病例在确定适应证时需要特别仔细的判断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.