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 |
Group II |
|
Complete and reliable ligation, n (%) |
20,(66.7%) |
0 |
|
Incomplete but reliable ligation, n (%) |
5,(16.7%) |
0 |
|
Complete but unreliable ligation, n (%) |
- |
20,(76.9%) |
|
Incomplete and unreliable ligation, n (%) |
- |
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