Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience

doi:10.1016/j.urology.2015.01.053

Urology

Volume 85, Issue 6, June 2015, Pages 1466-1470

https://doi.org/10.1016/j.urology.2015.01.053 Get rights and content

Objective

To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in the hydrocele sac orifice.

Methods

A total of 125 consecutive cases of boys with unilateral pediatric hydrocele underwent minilaparoscopic repair between June 2008 and June 2013. The patients were divided into 2 groups. Group 1 consisted of 65 patients who underwent a 2-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. Group 2 included 60 patients who received a modified single-port, double-needle, minilaparoscopic surgery. An Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing in group 2. The principal outcome factors were assessed between the groups.

Results

A total of 151 minilaparoscopic procedures were performed in 125 patients (age range, 12-68 months; median, 21.5 months). In total, 26 extra procedures were performed for simultaneous repair of a potential contralateral patent processus vaginalis. No significant difference in operation time was noted between group 1 and group 2 (25.9 ± 6.4 vs 27.1 ± 5.5 minutes). The procedures were performed successfully without serious preoperative complications. During a median follow-up period of 18 months (range, 6-36 months), no postoperative hydrocele recurrence was encountered.

Conclusion

Our limited experience suggests that the modified single-port, double-needle, minilaparoscopic technique could be safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles.

Section snippets

Methods

Institutional review board approval was obtained before the initiation of the study. A total of 125 consecutive male children with a mean age of 22.3 months (range, 12-68 months) and with multiple peritoneal folds (≥2 folds) intraoperatively observed near the hydrocele sac orifice were included in this study, which was conducted between June 2008 and June 2013. Information regarding formal informed consent for the operation was provided by an interpreter, and permission was obtained from the

Results

Successful procedures were achieved in all the patients. No conversion occurred in either group, and no serious complications, such as damage to the vas deferens and the gonadal vessels, severe postoperative infection, or hemorrhage, were noted. Detailed operation parameters and the distinctive baseline characteristics of the patients are summarized in Table 1. The median patient age was 22.3 months (range, 12-68 months). The patients were divided into the following 5 subgroups according to

Comment

PPVs are a common cause of pediatric hydroceles, which occur in approximately 60% of infants.⁵ An indirect inguinal hernia has the potential to develop, and the more patent the processus vaginalis appears, the more likely the patient is to develop a hernia. PPVs can close spontaneously; spontaneous closure typically occurs in patients younger than 1 year of age as a result of ongoing PPV changes.⁶ No relevant literature is available regarding the exact timing of surgery for a child with a

Conclusion

In our study, we evaluated a single-port double-needle technique as an option for the extraperitoneal ligation of PPV in complicated pediatric hydroceles. Compared with the 2-port procedure, this technique leads to enhanced cosmetic outcomes. Moreover, the technique is feasible, safe, and effective.

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Cited by (12)

Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center
2016, Journal of Pediatric Urology
Citation Excerpt :
In addition to not requiring suturing and knotting, the single-port LPEC procedure also achieves completely ligation of the hernia sac in the extraperitoneal space, maintaining the ligature on the same path of the abdominal wall and avoiding injury to the spermatic vessels and vas deferens. The procedure allows sufficient maneuvering and is feasible for expanding the multiple peritoneal folds covering the inner ring of the inguinal canal in some cases [8]. However, as with traditional inguinal herniorrhaphy, LH is associated with the potential development of surgical complications, such as scrotal hematomas, testicular atrophy and injury to the vas deferens.
To investigate the influence of single-port laparoscopic percutaneous extraperitoneal closure (LPEC) on the orientation of the vas deferens and testicular perfusion and volume in pediatric patients undergoing inguinal hernia repair.
A total of 92 consecutively enrolled boys preoperatively diagnosed with a unilateral inguinal hernia underwent single-port LPEC between June 2013 and June 2014. The orientation of the vas deferens and the testicular perfusion and volume of these patients were ultrasonographically assessed preoperatively, one month after surgery and six months after surgery.
The surgical procedures were performed successfully without conversion or serious perioperative complications. Ultrasonography showed no angulation or distortion of the vas deferens on the surgical side during a six-month follow-up period. Similarly, there were no perioperative changes in testicular perfusion or volume.
Our experience suggests that the single-port LPEC technique can be safe and effective in pediatric patients with an inguinal hernia and that this technique does not affect the orientation of the vas deferens or testicular perfusion or volume.
Laparoscopic percutaneous closure of patent processus vaginalis without hydrocelectomy for childhood primary hydrocele
2023, Pediatric Surgery International
Laparoscopic management of infantile hydrocele in pediatric age group
2022, Pediatric Surgery International
Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery
2021, BMC Surgery
Laparoscopic vs. Open Repair Surgery for the Treatment of Communicating Hydrocele in Children: A Retrospective Study From a Single Center
2021, Frontiers in Surgery
Single-Site Laparoscopic Percutaneous Extraperitoneal Closure (SLPEC) of the Internal Ring Using a Homemade Sled Needle
2021, Indian Journal of Surgery

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: Yonghui Peng and Canqiang Li contributed equally to this study.

: This study was approved by the institutional review board of the Affiliated Hexian Memorial Hospital of Southern Medical University.

: Financial Disclosure: The authors declare that they have no relevant financial interests.

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Pediatric UrologyApplication of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Comment

Conclusion

J Pediatr Surg

J Urol

J Pediatr Surg

Laparoscopic repair of pediatric hydroceles

J Endourol

Laparoscopic extraperitoneal repair of symptomatic hydrocele in children: a single-center experience with 73 surgeries

J Endourol

Modified single-port minilaparoscopic extraperitoneal repair for pediatric hydrocele: a single-center experience with 279 surgeries

World J Urol

Decision making in the management of hydroceles in infants and children

Eur J Pediatr

Pediatric Urology
Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience