Needlescopic Inversion and Snaring of Hernia in Girls

NCT04628455 | Completed

• 1 other identifier: PS2020-1002
• Study Type: interventional
• Target: 53
• Locations: 1 country
• Sites: 2

Brief Summary

Two Millimetres needlescopic instruments induce minimal damage to the abdominal wall and have excellent cosmetic results. However, these instruments are fragile and expensive with short weak jaws. The aim of this study is to present a novel needlescopic approach using 1.6-mm Suture Grasper Device \[SGD\], modified polypectomy snare and a home-made Snare (HMS) for the treatment of congenital inguinal hernias \[CIH\] in girls. Over a period of one year from March 2018 to March 2019 a prospective study was conducted in three tertiary centres on 53 girls presented with CIH. Preoperative inguinoscrotal U/S was done for all patients to confirm the diagnosis and to measure the diameter of internal inguinal ring \[IIR\]. All patients were repaired using needlescopic inversion and snaring of the hernia sac using 2-SGDs and a snare. Follow up period ranged from 12 to 24 (Median 16.5) months. Fifty-three girls with 74 hernias were included in this study. Their mean age was 37.8 months. Internal inguinal ring diameter (IIR) ranged between 8-15 mm with a mean of 11.8±2.8mm. Mean operative time was 15.5 minutes in bilateral and 11.4 minutes in unilateral cases. Mean operative time for inversion, snaring, and sac extraction was 4.2±1.3 minutes. All cases were completed successfully without conversion and without complications. Follow up period ranged from 12 to 24 (Median 16.5) months with non-visible scar and no recurrence among the studied patients. Needlescopic inversion and snaring of inguinal hernia using 1.6mm instruments is a safe, rapid and feasible method for CIH repair in girls with invisible scar and no short-term recurrence.

Conditions

Inguinal Hernia; Polyps; Fallopian Tube Injury; Round Ligament; Anomaly

Outcome Measures

Primary Outcomes (1)

• Recurrence of Hernia

  All patients were examined clinical and by U/S for detection of the recurrence

  every month up to one year postoperative

Secondary Outcomes (1)

• Operative time

  every minute up to 2 hours (the end of the surgery)

Study Arms (1)

Inversion and Snaring

OTHER

needlescopic inversion, snaring, and excision of the hernia sac using two Suture Grasper Sevice of Mediflex Company and a home made snare

Device: Inversion and snaring

Interventions

Inversion and snaring DEVICE

Vertical umbilical 5-mm incision was made for 5-mm trocar. Pneumoperitoneum is then established with CO2 flow of 1.5-2.5 L/min keeping intraabdominal pressure between 8-12 mmHg. A two-mm incision was done at a point B \[midway between umbilicus and symphysis pubis\] for 2-mm port passed under direct vision and a tiny 11-blade scalpel puncture is done at the corresponding Mac-Burney's \[Point C\] for SGD. Both SGDs were used to invert the hernia sac by gradual sustained alternating traction on the round ligament. Each SGD hands to the other one till complete inversion occurs, this is known by the hernial sac hanging from internal ring without retracting-back inside the inguinal canal. Then, the MPS is introduced via 2-mm trocar at point. SGD-C passed inside the loop of MPS and re-catches the hernial sac, which is then twisted around its neck several times. MPS was closed at the neck and diathermy current is applied. Detached sac was then pushed antigradely out through the umbilical port.

Inversion and Snaring

Eligibility Criteria

• Age: 6 Months - 10 Years
• Gender Eligibility Details: Bilateral inguinal hernia, Unilateral inguinal hernia
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Bilateral congenital inguinal hernia Unilateral congenital inguinal hernia Hernia defect siameter less than 1.5 mm

You may not qualify if:

• Recurrent hernia age less than 6 Month Contraindication to laparoscopy

Sponsors & Collaborators

• Al-Azhar University: lead

Study Sites (2)

Rafik Sahalaby

Cairo, Egypt

Location

Rafik Shalaby

Cairo, Egypt

Location

Related Publications (21)

• McClain L, Streck C, Lesher A, Cina R, Hebra A. Laparoscopic needle-assisted inguinal hernia repair in 495 children. Surg Endosc. 2015 Apr;29(4):781-6. doi: 10.1007/s00464-014-3739-8. Epub 2014 Aug 9.

  PMID: 25106720 BACKGROUND

• Schier F. Laparoscopic herniorrhaphy in girls. J Pediatr Surg. 1998 Oct;33(10):1495-7. doi: 10.1016/s0022-3468(98)90483-3.

  PMID: 9802799 BACKGROUND

• Wang K, Cai J, Lu YC, Li XW, Zhai GM, He WB, Guo XS, Wu GQ. A Faster and Simpler Operation Method for Laparoscopic Inguinal Hernia Repair in Children. J Laparoendosc Adv Surg Tech A. 2020 Jun;30(6):706-711. doi: 10.1089/lap.2019.0598. Epub 2020 Mar 27.

  PMID: 32216722 RESULT

• Kantor N, Travis N, Wayne C, Nasr A. Laparoscopic versus open inguinal hernia repair in children: which is the true gold-standard? A systematic review and meta-analysis. Pediatr Surg Int. 2019 Sep;35(9):1013-1026. doi: 10.1007/s00383-019-04521-1. Epub 2019 Jul 10.

  PMID: 31292721 RESULT

• Chan IH, Tam PK. Laparoscopic Inguinal Hernia Repair in Infants and Children: State-of-the-Art Technique. Eur J Pediatr Surg. 2017 Dec;27(6):465-471. doi: 10.1055/s-0037-1608685. Epub 2017 Nov 22. No abstract available.

  PMID: 29166678 RESULT

• Gause CD, Casamassima MGS, Yang J, Hsiung G, Rhee D, Salazar JH, Papandria D, Pryor HI 2nd, Stewart D, Lukish J, Colombani P, Chandler NM, Johnson E, Abdullah F. Laparoscopic versus open inguinal hernia repair in children </=3: a randomized controlled trial. Pediatr Surg Int. 2017 Mar;33(3):367-376. doi: 10.1007/s00383-016-4029-4. Epub 2016 Dec 26.

  PMID: 28025693 RESULT

• Barroso C, Etlinger P, Alves AL, Osorio A, Carvalho JL, Lamas-Pinheiro R, Correia-Pinto J. Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children. Front Pediatr. 2017 Sep 27;5:207. doi: 10.3389/fped.2017.00207. eCollection 2017.

  PMID: 29021976 RESULT

• Zallen G, Glick PL. Laparoscopic inversion and ligation inguinal hernia repair in girls. J Laparoendosc Adv Surg Tech A. 2007 Feb;17(1):143-5. doi: 10.1089/lap.2006.0553.

  PMID: 17362194 RESULT

• Guner YS, Emami CN, Chokshi NK, Wang K, Shin CE. Inversion herniotomy: a laparoscopic technique for female inguinal hernia repair. J Laparoendosc Adv Surg Tech A. 2010 Jun;20(5):481-4. doi: 10.1089/lap.2009.0169.

  PMID: 20367121 RESULT

• Xi HW, Duan WQ, Cui QQ, You ZH, Zhao Z, Zhang P. Transumbilical Single-Site Laparoscopic Inguinal Hernia Inversion and Ligation in Girls. J Laparoendosc Adv Surg Tech A. 2015 Jun;25(6):522-5. doi: 10.1089/lap.2014.0383. Epub 2015 May 5.

  PMID: 25941750 RESULT

• Ostlie DJ, Ponsky TA. Technical options of the laparoscopic pediatric inguinal hernia repair. J Laparoendosc Adv Surg Tech A. 2014 Mar;24(3):194-8. doi: 10.1089/lap.2014.0081.

  PMID: 24625350 RESULT

• Lipskar AM, Soffer SZ, Glick RD, Rosen NG, Levitt MA, Hong AR. Laparoscopic inguinal hernia inversion and ligation in female children: a review of 173 consecutive cases at a single institution. J Pediatr Surg. 2010 Jun;45(6):1370-4. doi: 10.1016/j.jpedsurg.2010.02.113.

  PMID: 20620347 RESULT

• Chen YN, Chang LC, Chang CY, Chen PJ, Chen CY, Tseng CH, Chiu HM. Comparison of cold and hot snaring polypectomy for small colorectal polyps: study protocol for a randomized controlled trial. Trials. 2018 Jul 6;19(1):361. doi: 10.1186/s13063-018-2743-z.

  PMID: 29980220 RESULT

• Blatnik JA, Harth KC, Krpata DM, Kelly KB, Schomisch SJ, Ponsky TA. Stitch versus scar--evaluation of laparoscopic pediatric inguinal hernia repair: a pilot study in a rabbit model. J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):848-51. doi: 10.1089/lap.2012.0137. Epub 2012 Sep 18.

  PMID: 22989037 RESULT

• Shalaby R, Elsaied A, Shehata S, Shehata S, Hamed A, Alsamahy O, Ashour Y, Elsayaad I, Shahin M. Needlescopic assisted internal ring suturing; a novel application of low-cost home-made instruments for pediatric inguinal hernia repair. Hernia. 2019 Dec;23(6):1279-1289. doi: 10.1007/s10029-019-01982-0. Epub 2019 May 25.

  PMID: 31129795 RESULT

• Novotny NM, Puentes MC, Leopold R, Ortega M, Godoy-Lenz J. The Burnia: Laparoscopic Sutureless Inguinal Hernia Repair in Girls. J Laparoendosc Adv Surg Tech A. 2017 Apr;27(4):430-433. doi: 10.1089/lap.2016.0234. Epub 2017 Mar 30.

  PMID: 28358588 RESULT

• St-Louis E, Chabot A, Stagg H, Baird R. Experience with peritoneal thermal injury during subcutaneous endoscopically assisted ligation for pediatric inguinal hernia. J Pediatr Surg. 2018 May;53(5):968-972. doi: 10.1016/j.jpedsurg.2018.02.024. Epub 2018 Feb 9.

  PMID: 29501237 RESULT

• Chock A, Seslar S, Stoopen E, Tristan A, Hashish H, Gonzalez JJ, Franklin ME Jr. Needlescopic appendectomy. Surg Endosc. 2003 Sep;17(9):1451-3. doi: 10.1007/s00464-002-8732-y. Epub 2003 Jun 19.

  PMID: 12811662 RESULT

• Wada H, Kimura T, Kawabe A, Sato M, Miyaki Y, Tochikubo J, Inamori K, Shiiya N. Laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments: a 15-year, single-center experience in 317 patients. Surg Endosc. 2012 Jul;26(7):1898-902. doi: 10.1007/s00464-011-2122-2. Epub 2012 Jan 6.

  PMID: 22223115 RESULT

• Schier F. Laparoscopic appendectomy with 1.7-mm instruments. Pediatr Surg Int. 1998 Nov;14(1-2):142-3. doi: 10.1007/s003830050465.

  PMID: 9880727 RESULT

• Shalaby R, Abdalrazek M, Hamed A, Elhady S, Ibrahim R, Shahin M, Helal A, Elsaied A, Mohamad S, Mahfouz M, Elsherbeny M, El-Lithy MM. Novel application of the sewing machine principle; a new simplified intracorporeal suturing technique for pediatric inguinal hernia. J Pediatr Surg. 2019 Jul;54(7):1505-1509. doi: 10.1016/j.jpedsurg.2019.01.054. Epub 2019 Feb 18.

  PMID: 30827487 RESULT

MeSH Terms

Conditions

Hernia, Inguinal; Polyps; Congenital Abnormalities

Condition Hierarchy (Ancestors)

Hernia, Abdominal; Hernia; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Study Officials

• Rafik Y Shalaby, MD

  Al-Azhar University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Pediatric Surgery

Model Details: Both SGDs were used to invert the hernia sac by gradual sustained alternating traction on the round ligament. Each SGD hands to the other one till complete inversion occurs, this is known by the hernial sac hanging from internal ring without retracting-back inside the inguinal canal. . SGD-C passed inside the loop of MPS and re-catches the hernial sac, which is then twisted around its neck several times. MPS is closed tightly at the proper neck and coagulation diathermy current is applied.Detached sac was then pushed antigradely out through the umbilical port.

Study Record Dates

• First Submitted: May 15, 2020
• First Posted: November 13, 2020
• Study Start: April 1, 2018
• Primary Completion: June 2, 2019
• Study Completion: July 2, 2019
• Last Updated: November 13, 2020

Record last verified: 2020-11

Data Sharing

• IPD Sharing: Will not share

Locations

EG (2)