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Oral Presentation - 46
Pediatric inguinal hernia repair with laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal percutaneous internal ring suture (PIRS) and intra-corporal purse-string suture for inguinal hernia
Roxanne Eurlings 1, Lore de Vreeze 2, Hamit Cakir 1, Stefi Nordkamp 1, Marc Dirix 1, Olivier Theeuws 1, Sylwester Gerus 3, Mateusz Palczewski 3, Joep Derikx 2, Dariusz Patkowski 3, Wim van Gemert 1, Ruben Visschers 1
1 Maastricht University Medical Center+
2 Amsterdam University Medical Center
3 Wroclaw Medical University
Introduction: Techniques for inguinal hernia repair (IHR) in children are continuously being improved. Open repair is increasingly giving way to laparoscopy, with two possible approaches for laparoscopy: extra-peritoneally (Percutaneous Internal Ring Suturing, PIRS) or intra-peritoneally (conventional laparoscopy with purse-string suture). The aim of this trial is to compare outcomes, e.g. recurrence and anesthesia times, of PIRS with intra-corporeal laparoscopy using a purse-string suture (LIHR).
Methods: Subjects were prospectively included in the ‘Pediatric Inguinal Hernia Repair with Laparoscopy’ (PIHRL)-trial, to undergo surgery with PIRS or LIHR. Follow-up was conducted one year after surgery. Data concerning post-operative complications and anesthesia times were collected. Parents were asked to complete two questionnaires (POSAS and TAPQoL/TACQoL) to assess cosmetic results and quality of life.
Results: 177 subjects were included (PIRS n=126, LIHR n=51). There was a baseline difference in age between the groups from the different centers. Total anesthesia time was significantly shorter with PIRS (62.1+24.6min vs. 84.7+21.7min, p=0.001). One readmittance within 30 days occured in the LIHR group due to hemorrhage. This resolved spontaneously without the need for intervention. There was a significant difference in recurrence rate (PIRS n=2, LIHR n=4, p=0.038). One patient in the PIRS group suffered from testicular atrophy (p=0.523) and five re-interventions were necessary after PIRS due to wound complications (p=0.984).
Discussion: PIRS is safe and effective for pediatric IHR, with shorter anesthesia times and a lower recurrence rate compared to LIHR at one year follow-up. Longer follow-up and a larger sample size are necessary to confirm these results.