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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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ULTRASOUND-GUIDED DISSECTION AND LIGATION OF THE INTERNAL INGUINAL RING FOR HERNIA REPAIR IN PEDIATRICS: AN EXPERIMENTAL ANIMAL STUDY

Pedro Reino-Pires1,2,3, José Miguel Pêgo1,2, Alice Miranda1,2, Catarina Barroso1,2,4, Margarida Espanha3, Jorge Correia-Pinto1,2,4

1. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal;
2. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal;
3. Department of Pediatric Surgery, Hospital Dona Estefânia, CHLC, Lisboa, Portugal;
4. Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal.

- 50ª Reunião Científica da Sociedade Anatómica Portuguesa e 3ª Reunião Científica da Associação Anatómica Portuguesa, Braga, 30 de Abril de 2016
- VI Annual Congress European Society Of Paediatric Endoscopic Surgeons, Masdrid, Espaha, 20-30 Setembro 2016 (comunicação oral)
- Reunião anual da Sociedade Portuguesa de Cirurgia Pediátrica, Lisboa 11 e 12 de Novembro de 2016 (comunicação oral – prémio de melhor comunicação oral)

Aim of the Study: We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring ligation in rabbits, as a model for inguinal hernia repair in Pediatrics.
Methods: Twenty-eight rabbits were divided in 2 groups. Group I (female morphology) - persistence of the peritoneal-vaginal duct with gonads placed laparoscopically in intra-peritoneal position; Group II (male morphology) - Persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image provided by a 13 MHz-transducer, we tried to perform a complete and reliable pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G AbbocathTM and 2-0 non-absorbable suture (both sides). Afterwards, an exploratory laparoscopy was performed to evaluate the quality of the ligation. Ethics and animal welfare followed the recommendations of the EU directive 2010/63/EU and Portuguese law 113/2013.
Results: Ultrasound allowed reasonable characterization of inguinal-crural structures. In the table, we summarize the results regarding the quality of the achieved peritoneal-vaginal duct ligation (please note that gonadic vessels in rabbit model are totally intraperitoneal). No acute complications (bowel, bladder or major vessel injury) were logged.

 

Group I
(female morphology)

Group II
(male morphology)

Complete and reliable ligation, n (%)
(no gaps and no gonadic vessels entrapped)

20,(66.7%)

0

Incomplete but reliable ligation, n (%)
(with minor gaps but no gonadic vessels entrapped)

5,(16.7%)

0

Complete but unreliable ligation, n (%)
(with no gaps but with gonadic vessels entrapped)

-

20,(76.9%)

Incomplete and unreliable ligation, n (%)
(with minor gaps and gonadic vessels entrapped)

-

3,(11.5%)

Inappropriate ligation, n (%)

5,(16.7%)

3,(11.5%)

Conclusions: Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible in a high percentage of cases and likely reliable, namely for female inguinal hernia repair.

Palavras-chave: pediatric surgery, inguinal hernia ligation, exclusively ultrasound guided surgery