Short-Term Outcomes of Simultaneous Inguinal Hernia Repair at Laparoscopic Appendectomy in Children: Cohort Study

Background. Nowadays, simultaneous techniques have been widely adopted in abdominal pediatric surgery as they allow to perform surgical interventions for several diseases at the same time. However, the safety of such interventions requires further studies. Objective. The aim of the study is to analyze the short-term outcomes of simultaneous hernia repair in laparoscopic appendectomy in children. Methods. The study included data from patients hospitalized with suspected acute appendicitis in 2022–2023. The study group included children operated for acute appendicitis and who had signs of patent processus vaginalis. Percutaneous internal ring suturing (PIRS) was performed in all cases. The control group (no indirect inguinal hernia was revealed) was formed by pairwise matching of patients by gender, age (± 1 year), and appendicitis type. The surgery time, the blood loss volume, the beginning of enteral feeding, and the presence of postoperative complications were analyzed. Results. The compared groups (13 individuals each) were comparable in gender (38% boys), age (median age about 10 years), and appendicitis type (catarrhal — 31%, phlegmonous — 38%, gangrenous — 31%), and white cell count at admission, presence of serous exudate and omentum changes revealed during surgery. The beginning of enteral feeding, the stool, as well as total duration of hospital stay after surgery did not differ in two groups. Moreover, both groups were comparable in terms of surgery duration, intraoperative blood loss volume, pain syndrome severity. No pyo-inflammatory complications of abdominal cavity or postoperative wounds were revealed during the hospital stay. Conclusion. Simultaneous hernia repair via PIRS method is effective and safe method of surgical management of pediatric patients with combination of acute appendicitis and inguinal hernia.

1. Svensson JF, Patkova B, Almström M, et al. Outcome after introduction of laparoscopic appendectomy in children: A cohort study. J Pediatr Surg. 2016;51(3):449–453. doi: https://doi.org/10.1016/j.jpedsurg.2015.10.002

2. Zhang Z, Wang Y, Liu R, et al. Systematic review and metaanalysis of single-incision versus conventional laparoscopic appendectomy in children. J Pediatr Surg. 2015;50(9):1600–1609. doi: https://doi.org/10.1016/j.jpedsurg.2015.05.018

3. Korovin SA, Dzyadchik AV, Dvorovenko EV, Sokolov YuYu. Laparoscopic interventions in children with complicated appendicitis. Meditsinskiy sovet = Medical Council. 2018;(17):232–236. (In Russ). doi: https://doi.org/10.21518/2079-701X-2018-17-232-23622

4. Zhang S, Du T, Jiang X, Song C. Laparoscopic appendectomy in children with perforated appendicitis: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2017;27(4):262–266. doi: https://doi.org/10.1097/SLE.0000000000000411

5. Svarich VG, Perevozchikov EG, Kagantsov IM. Unligature method of laparoscopic appendectomy in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(1):53–58. (In Russ). doi: https://doi.org/10.17816/psaic583

6. Huang FH, Cheng PL, Hou WH, Duh YC. Laparoscopic hernia repair with the extraperitoneal approach versus open hernia repair in pediatric inguinal hernia: a systematic review and meta-analysis. J Clin Med. 2022;11:321-335. doi: https://doi.org/10.3390/jcm11020321

7. Dyakonova EYu, Gusev AA, Bekin AS, Romanova EA. Laporoscopic Surgery as the Gold Standard for the Treatment of Inguinal Hernia in Children. Pediatricheskaya farmakologiya — Pediatric pharmacology. 2018;15(1):90–94. (In Russ). doi: https://doi.org/10.15690/pf.v15i1.1848

8. Ignatyev RO, Batayev SM. Extraperitoneal ligation herniorraphy by the acute infectious diseases of the abdominal cavity in children. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2012;(11):69–72 (In Russ).

9. Poddubnyi IV, Isaev AA, Ternavskii AP, et al. Simul’tannye laparoskopicheskie operatsii v detskoi khirurgii. Khirurg. 2008;(12):48–57. (In Russ).

10. Quezada N, Maturana G, Pimentel E, et al. Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series. Hernia. 2019;23:119–123. doi: https://doi.org/10.1007/s10029-018-1824-y

11. Timerbulatov VM, Mekhdiev DI, Timerbulatov ShV, et al. Simultaneous abdominal and retroperitoneal surgery. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2016;(3):40–44. (In Russ). doi: https://doi.org/10.17116/hirurgia2016340-44

12. Ferris M, Quan S, Kaplan BS, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017;2(266):237–241. https://doi.org/10.1097/SLA.0000000000002188

13. Li Y, Guo Z, Qu Z, et al. Laparoscopic simultaneous inguinal hernia repair and appendectomy in children: A multicenter study. J Pediatr Surg. 2022;57(8):1480–1485. doi: https://doi.org/10.1016/j.jpedsurg.2022.03.007

14. Order of the Ministry of Health of the Russian Federation dated May 10, 2017 No. 203н. “Ob utverzhdenii kriteriev ocenki kachestva medicinskoj pomoshhi”. (In Russ)

15. Ostryi appenditsit u detei: Federal clinical guidelines. Moscow; 2013. (In Russ).

16. Korovin AJa, Kulish VA, Vystupets BV, Turkin DV. Possibilities laparoscopic simultaneons repair of bilateral inguinal hernias. Kuban Scientific Medical Bulletin. 2010;(9):115–118. (In Russ).

17. Gallyamov EA, Agapov MA, Wu Z, et al. Safety of simultaneous laparoscopic appendectomy in combination with laparoscopic hernia repair (TAPP). A series of clinical cases. Surgical practice (Russia). 2022;(3):12–19. (In Russ). doi: https://doi.org/10.38181/2223-2427-2022-3-12-19