Results of the method of total extraperitoneal endoscopic assisted hernia sac ligation in children with inguinal hernia (Phelps)

The aim of the study was to evaluate the effectiveness of the new technology for laparoscopic treatment of inguinal hernia (IH) in children (PHELPS) in comparison with the popular extraperitoneal SEAL technique. Materials and methods of research: a retrospective comparative single-center non-randomized study was carried out. The analysis of the results of laparoscopic treatment of 680 patients with IH was performed, out of them 206 patients were operated on using the new PHELPS technique, in 474 cases the laparoscopic extraperitoneal SEAL technique was used. The gender composition of patients in the groups did not differ statistically significantly (m/f: 151/55–73.3%/26,7% versus 349/125–73.6%/26,4%, p=0,929). The median age of children in the PHELPS group was 169,5 [80,8; 261,3] days, in the SEAL group – 210,5 [78,0; 258,0] days (p=0,137). The difference between the new technique for treating IH in children consisted in the method of carrying out a hernial ligature around the neck of the hernial sac in such a way that the knot after percutaneous tying was located at the level of the peritoneum and did not include the tissues of the abdominal wall (aponeurosis and muscles). At the end of the study, a comparison of demographic data, intra-and postoperative results in the two groups of patients was made. Results: the median of the total duration of inguinal herniorrhaphy, including the operation time in patients with single and double sided hernia localization, confirmed statistically unchanged values of this indicator in the comparison groups (20,0 [15,0; 20,0] min versus 15,0 [15,0; 20,0] min, р=0,518). The study demonstrated a faster recovery of patients after using the PHELPS technique for the treatment of IH, with a statistically significantly lower number of doses of postoperative analgesia (1,0 [1,0; 1,0] versus 1,0 [1,0; 2,0 ], p<0,001) and a shorter hospital stay (8,0 [6,0; 8,0] hours versus 8,0 [8,0; 9,0] hours, p=0,031). Despite the fact that there were no statistically significant differences in the frequency of formation of dropsy of the testicle (0 (0,0%) versus 6 (1,3%), p=0,185), a statistically significantly better condition of patients was revealed as a result of the use of the innovative PHELPS technique, consisted in the absence of the return of symptoms of the disease – 0 (0,0%) versus 17 (3,6%), p=0,003. Conclusion: the new PHELPS method of treating IH in children allows to improve the quality of known extraperitoneal methods of treating the disease. The placement of a hernial ligature node at the level of the hernial sac neck, rather than over the aponeurosis, is expected to lead to a decrease in the number of relapses after surgery.