Cognition of umbilical two-port laparoscopic percutaneous extraperitoneal processus vaginalis closure for children: Pneumoperitoneum-induced anatomic changes of inguinal canal and peritoneal flexibility utilization

Abstract

Background

Umbilical two-port laparoscopic percutaneous extraperitoneal processus vaginalis closure (UTLPEPVC) has been performed for children recent years. In addition to the basic concept of preperitoneal closure of the proecessus vaginalis at the level of internal ring, more conceptual and skillful cognitions deserve to be further probed for a smoother and swifter performance.

Methods

From June 2021 to September 2021, 27 patients of 5 girls and 22 boys with a total of 45 patent processus vaginalis closure were consecutively performed UTLPEPVC by a laparoscopic novice and an experienced surgeon in our department. The video clips of all the procedures were recorded in a SanDisk. The needle piercing site, piercing route, piercing time, dissecting time and peritoneal puncture were defined, measured and evaluated between the novice and the expert. P ​< ​0.05 was statistically significant.

Results

There were no statistically significant differences between the novice group and the expert group for the following items, including patient age, sex constituent ratio, side of processus vaginalis constituent ratio, postoperative stay in hospital and postoperative follow-up time (P ​> ​0.05). There were no postoperative complications or open conversions for all the patients. The piercing time and the dissecting time of the novice were significantly longer than that of the expert (P ​= ​0.0000, 0.0000). Dissecting puncture occurred more frequently than that of the expert (P ​= ​0.0036). Due to unawareness of pneumoperitoneum-induced anatomic changes of the inguinal canal, the piercing site of the novice was higher than that of the expert. The piercing route of the novice did not directly operate from the external inguinal fossa compared to that of the expert. Furthermore, the novice's spatial orientation was not adequately developed with more peritoneum punctures and the inflexible clamping and lifting of the peritoneum during the dissecting process.

Conclusion

In UTLPEPVC for children, pneumoperitoneum-induced anatomic changes of the inguinal canal and peritoneal flexibility utilization deserve to be cognized.