• Complications of the surgical treatment in children with inguinal hernia with the applying of the open and mini-invasive methods

Complications of the surgical treatment in children with inguinal hernia with the applying of the open and mini-invasive methods

PAEDIATRIC SURGERY.2016.3-4(52-53):34-37; doi 10.15574/PS.2016.52-53.34 
 

Complications of the surgical treatment in children with inguinal hernia with the applying of the open and mini-invasive methods


Pereyaslov A. A., Dvorakevych A. O.

Danylo Halytsky Lviv national medical university, Ukraine

Lviv regional children’s clinical hospital «OHMATDYT», Ukraine


Introduction. Surgical interventions in children with the inguinal hernia are the most common operations in pediatric surgical clinics. Open surgery during the long time was considered as the gold standard in the treatment of this pathology. The development of mini-invasive surgery determined the applying of these methods in the treatment of children with the inguinal hernia. The aim of the study was to compare the complications, which arisen in children with the inguinal hernia during the open and mini-invasive treatment.


Material and methods. The study based on the results of the surgery of 1001 children with inguinal hernia that operated in surgical department Lviv regional children’s clinical hospital «OHMATDYT» during 2010–2015 years. The type of the open herniotomy depended of the age of patients: Duamel I type was applied in children aged 1–3 year; Duamel II type – in children aged 3–8 year, in patients over 8 years – Martynov or Roux-Krasnobaev type. Laparoscopic operations with the PIRS method were performed in 318 patients and open methods were applied in 683 children. Pneumoperitoneum is established using the open Hasson technique with the working pressure 5–10 mm Hg in dependence of patients’ age.


Results. Any operation, independently is it open or mini-invasive, may accompanied by the various pattern of complications that arisen during operation, early or in follow-up. The different complications after open surgery were noted in 24% of children; while after laparoscopic treatment the complications were noted in 7.2% of patients (p<0.05). The rate of hernia recurrence is an important criterion of the efficacy of the treatment of inguinal hernia. Recurrent hernia diagnosed in 2.8% of children after open herniotomy and in 1.3% – after laparoscopic treatment. Frequency of the testicular complications (hydrocele, retraction and hypoplasia) had no significant difference in both groups of patients. The possibility to simultaneously closure of the contralateral patent processus vaginalis is one of the advantages of laparoscopic herniotomy. Metachronous contralateral inguinal hernia developed in 7.9% of children after open herniotomy.


Conclusion. The frequency of particular complications in the postoperative period did not depended by the method of surgical correction. By that, the complications after laparoscopy not so often as after open surgery, but in most cases, except the frequency of the recurrence and development of intestinal obstruction, this difference is not significant. The general frequency of complications is higher after open surgery when compared with the mini-invasive methods.


Key words: children, inguinal hernia, open surgery, laparoscopy.


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