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    Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases
    (W B SAUNDERS CO-ELSEVIER INC, 2016) Thomas, David Terence; Gocmen, Kamil Basar; Tulgar, Serkan; Boga, Ibrahim
    Background/Purpose: Percutaneous internal ring suturing (PIRS) is a minimally invasive method for repair of pediatric inguinal hernia. In this study we report our experience with PIRS. Methods: All children >10 kg presenting to our institute between June 2013 and March 2015 with a diagnosis of indirect inguinal hernia or communicating hydrocele underwent laparoscopic repair using PIRS technique. Patients' gender, age at surgery, side of inguinal hernia/communicating hydrocele at diagnosis, peroperative findings, surgical and anesthesia times plus follow-up findings were collected. Results: Two-hundred thirteen patients underwent 250 procedures. Inguinal hernia or communicating hydrocele was diagnosed on the right side in 113 (53.1%), the left side in 75 (35.2%) and bilaterally in 25 patients (11.7%). Contralateral hernia was found in 35 patients (16.4%). Mean surgery time was 14.3 min for unilateral and 20.4 min for bilateral PIRS, and mean anesthesia time was 33.6 min for unilateral and 39.1 min for bilateral PIRS. Average follow-up time was 9.6 months. Recurrence was seen in 3 (1.4%) and complications in 6 patients (2.8%). Conclusion: PIRS is a simple, safe and effective method for the treatment of inguinal hernia and communicating hydrocele in children. (C) 2016 Elsevier Inc. All rights reserved.
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    Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway
    (W B SAUNDERS CO-ELSEVIER INC, 2017) Tulgar, Serkan; Boga, Ibrahim; Cakiroglu, Basri; Thomas, David Terence
    Purpose: Technical advances have led to lower insufflation pressures and shorter anesthesia times for children undergoing laparoscopic procedures. In this study we compared the use of endotracheal tube (ETT) and laryngeal mask airway (LMA) with or without muscle relaxant (MR) in children undergoing laparoscopic repair for inguinal hernia. Methods: Children undergoing laparoscopic inguinal hernia repair were randomized into four groups which underwent procedure with either ETT + MR (group 1), ETT without MR (group 2), LMA with subparalytic dose of MR (group 3) or LMA without MR (group 4). Surgical, anesthesia and recovery times, intragastric pressures and peak airway pressures during insufflation were compared. Results: After exclusion criteria and discontinued interventions, groups 1 and 3 contained 20, groups 2 and 4 contained 19 patients each. Surgical times were similar between groups. Anesthesia times were statistically significantly different between groups with shortest time in group 4 and longest time in group 1. Recovery time was statistically significantly longer in group 1 when compared to other groups. There was no difference between basal intragastric pressure, average intragastric pressure during insufflation, peak airway pressure, and average peak airway pressure during insufflation of groups. Conclusion: Use of muscle relaxants in short-lasting laparoscopic procedures in children is not absolutely necessary and LMA with subparalytic dose of muscle relaxant or with no muscle relaxant is a safe alternative. (C) 2017 Elsevier Inc. All rights reserved.