ADDITION OF PERITONEAL DISSECTION OR CAUTERIZATION TO PURSE STRING SUTURE DURING INGUINAL HERNIA REPAIR INCREASES PERI-HERNIA SAC NECK COLLGEN FORMATION

C Kural¹, O Ulusoy¹, B Yücesoy¹, O Ateş², G Hakgüder², S Aktaş³, M Olguner², F Akgür²

¹Dept. of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
²Department of Pediatric Surgery, Division of Pediatric Urology, Dokuz Eylül University, Medical school, İzmir
³Department of Basic Oncology, Dokuz Eylul University, Oncology Institute, Izmir, Turkey

Aim of the study: The worldwide accepted repair for indirect inguinal hernia in children is high ligation of the hernia sac with open herniotomy. However, laparoscopic pediatric inguinal hernia repair has been gaining popularity in the last two decades. Many different surgical techniques are used in laparoscopic hernia repair nowadays. An experimental study was conducted to investigate the effects of different peritoneal injury techniques added to hernia repair on collagen deposition at the hernia sac neck.

Methods: Present study was conducted on thirty-five adult (3-6 month old, 260-350 g) Wistar Albino male rats. There were five experimental groups;

Control group: no intervention

Sham group: inguinal canal was held and released with forceps

Suture group: inguinal canal is closed with purse string and transfixion sutures

Peritoneal dissection+suture group: peritoneal dissection followed by purse string and transfixion sutures

Cauterization+suture group: Peritoneal cauterization followed by purse string and transfixion sutures

All procedures were performed through median laparotomy using open operative techniques. Collagen deposition around the hernia sac neck repair was measured microscopically three weeks later.

Main results: Collagen deposition around hernia sac neck repair in Peritoneal dissection+suture and Cauterization+suture group was found to be statistically higher when compared with other groups (p<0.001). Collagen deposition around the hernia sac neck repair in Cauterization+suture group was found to be the highest among groups (p<0.05).

Conclusions: The combined usage of peritoneal injury and suture during inguinal hernia repair further stimulates mesothelial fibrosis at the hernia sac neck compared with mesothelial fibrosis induced by suture techniques only.

Keywords: inguinal hernia, pediatric inguinal hernia repair, laparoscopic inguinal hernia repair, laparoscopic, experiment, peritoneal injury

C Kural¹, O Ulusoy¹, B Yücesoy¹, O Ateş², G Hakgüder², S Aktaş³, M Olguner², F Akgür²

¹Dokuz Eylül Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı
²Dokuz Eylül Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Bilim Dalı, İzmir
³Dokuz Eylül Üniversitesi Onkoloji Enstitüsü Temel Onkoloji Anabilim Dalı, İzmir

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