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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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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 Pires 1, José Miguel Pêgo2, Alice Miranda2, Catarina Barroso3, Margarida España1, Jorge Correia-Pinto2

1. Serviço de Cirurgia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2. Departamento de Ciências Cirúrgicas, ICVS/3B’s, Universidade do Minho
3. Serviço de Cirurgia Pediátrica, Hospital de Braga

- Publicação no Journal Of Pediatric Surgery (Abril 2017)

Purpose: We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population.
Methods: Twenty-eight rabbits were divided in 2 groups: group I (female morphology) - persistence of the peritoneal–vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) - persistence of the peritoneal–vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal–vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2–0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation.
Results: Ultrasound allowed characterization of inguinal–crural structures. Group I – complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II – complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged.
Conclusions: Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair.

Palavras-chave: Minimally invasive, Surgery, Laparoscopy, Rabbits, Ultrasound