External squeeze test during pediatric laparoscopic hernia repair: a novel on-table assessment to ensure complete closure of patent processus vaginalis

IF 0.6 Q4 SURGERY

Open Access Surgery Pub Date : 2018-04-11 DOI:10.2147/OAS.S163265

D. Aziz, Marjmin Osman, Felicia Lim, Rufinah Teo, Z. Latiff, R. A. Manaf

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引用次数: 1

Abstract

Background: In pediatric patients, recurrent inguinal hernia (IH) after laparoscopic repair mostly occurs secondary to incomplete closure of the patent processus vaginalis (PPV). The “external squeeze test” (EST) is a simple on-table assessment tool to check completeness of closure of PPV during laparoscopic IH repair. Patients and methods: A review of effectiveness of EST and recurrence of IH was carried out at our institution from December 2007 to December 2017. Closure of PPV was achieved with creation of purse string over pre-peritoneal fascia of the deep inguinal ring with avoidance of important structures; EST was then performed, that is, a gentle squeeze on the scrotum or labia majora while the telescope remains focused at the pursed area. If the closure was incomplete, EST would result in escape of CO 2 from within the scrotum or labia back into the peritoneal cavity, visualized as air bubbles internally and taken as a positive EST. A complete closure of PPV would not produce any bubbles internally upon external pressure; this would be taken as a negative EST. All patients had 1- to 12-month follow-up. Results: A total of 874 PPVs were repaired. EST was performed in 870 PPVs (99.5%). There were five recurrences of PPVs consistent with recurrent IH (0.57%); one was in a patient with negative EST, attributed to a slipped ligature; the other four did not have EST performed ( p < 0.000000). All the recurrences were re-repaired laparoscopically. Conclusion: EST is a simple, useful on-table assessment tool which significantly detects completeness of closure of PPV which may prevent recurrence of IH. We highly recommend EST in pediatric laparoscopic hernia repair, especially in large PPV. Patient care around the peri-operative period and patient outcomes post surgery are key topics for the journal. All grades of surgery from minor cosmetic interventions to major surgical procedures are covered. Novel techniques and the utilization of new instruments and materials, including implants and prostheses that optimize outcomes constitute major areas of interest. The manuscript management system is completely online includes a very quick and fair peer-review system,

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儿童腹腔镜疝修补术中的外部挤压试验:一种新颖的表上评估方法，以确保阴道上突未闭完全闭合

背景：在儿科患者中，腹腔镜修补术后复发性腹股沟疝（IH）大多发生在阴道突未闭（PPV）不完全闭合后。“外部挤压试验”（EST）是一种简单的评估工具，用于检查腹腔镜IH修复过程中PPV闭合的完整性。患者和方法：我们于2007年12月至2017年12月对EST的有效性和IH复发进行了审查。PPV的闭合是通过在腹股沟深环腹膜前筋膜上创建荷包线来实现的，避免了重要的结构；然后进行EST，即在阴囊或大阴唇上轻轻挤压，同时望远镜仍聚焦在凹陷区域。如果闭合不完全，EST将导致CO2从阴囊或阴唇内逃逸回腹膜腔，在内部显示为气泡，并被视为阳性EST。PPV的完全闭合不会在外部压力的作用下在内部产生任何气泡；这将被视为负EST。所有患者均进行了1至12个月的随访。结果：共修复了874例PPV。870例PPV（99.5%）行EST，其中5例PPV复发符合IH复发（0.57%）；其中一例患者的EST为阴性，归因于结扎失误；其余4例未行EST（p＜0.00000），所有复发均经腹腔镜再次修复。结论：EST是一种简单、实用的表上评估工具，可以显著检测PPV闭合的完整性，从而防止IH复发。我们强烈推荐EST用于小儿腹腔镜疝修补术，尤其是在大PPV中。围手术期的患者护理和患者手术后的结果是该杂志的关键主题。涵盖从小型美容干预到大型外科手术的所有级别的手术。新技术和新仪器和材料的利用，包括优化结果的植入物和假体，是人们感兴趣的主要领域。手稿管理系统是完全在线的，包括一个非常快速和公平的同行评审系统，

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来源期刊

Open Access Surgery SURGERY-

自引率

0.00%

发文量

审稿时长

16 weeks

期刊介绍： Open Access Surgery is an international, peer-reviewed, Open Access journal that focuses on all aspects of surgical procedures and interventions. Patient care around the peri-operative period and patient outcomes post surgery are key topics for the journal. All grades of surgery from minor cosmetic interventions to major surgical procedures will be covered. Novel techniques and the utilization of new instruments and materials, including implants and prostheses that optimize outcomes constitute major areas of interest. Contributions regarding patient satisfaction, preference, quality of life, and their role in optimizing new surgical procedures will be welcomed. The journal is characterized by the rapid reporting of case reports, clinical studies, reviews and original research.