Dear Colleagues,
Good day. Laparoscopic PIRS is a procedure that closes the patent deep inguinal ring mainly in paediatric indirect hernia without posterior wall weakness. No mesh is used in this procedure.
Upon my brief literature review, patients that have underwent Lap PIRS ranges 4 weeks old to 17 years old have been reported.
May I know anyone has any experience on performing Lap PIRS on older teenage or young adult?
Is there a limit to the size of the deep ring defect? How do we check for posterior wall weakness in laparoscopy?
Many thanks in advance.
In our unit we have protocol for pirs till 12 yr age group but beyond this we haven't tried
The laparoscopic needle assisted technique for repair of indirect inguinal hernia in infants and children is a suitable technique for pediatric patients but NOT adult patients. We have had extensive experience here at the Medical University of South Carolina. It is our practice to avoid the procedure in children older than 12 years of age. We have found that in older children the opening at the internal ring can be large enough that simple "purse-string suture closure" may not be enough for the repair. I have personally had recurrences when the procedure was performed in large children older than 12.
Please note that if the patient has a "direct" component to the inguinal hernia, this should be visible at the time of laparoscopy and such patients are NOT good candidates for the needle assisted technique alone.
The important thing is to asses the posterior inguinal wall weakness for the percutaneous inguinal ring suturing rather than taking a decision on the basis of age limit. suturing can be done even in the age of 17 or 18 years of age if there is no posterior inguinal wall weakness
Dear esteemed colleagues,
Thank you for your response.
I agree very much with Dr. Maqlik that PIRS is to close simple indirect hernia with no posterior wall weakness and age should not be the limit.
Dr. Hebra, I agree with you too if the defect is large, recurrence rate maybe high. Do you feel that they may have less recurrence if simple herniotomy is performed?
May I know how do we assess the posterior wall weakness during laparoscopy?
Unfortunately some colleagues do something that is beyond the standard medicine or avoid to release late results of such procedures. If you do any such procedure which is not common for standard medical procedures is properly disclosed and late results. So we can draw conclusions about the validity of a medical procedure. ARDS is a method reserved for children 12-14 years of age, provided that they have little direct hernia with a narrow inner ring. The patient we have to work those methods that provide the best rezultate.Palpation through the outer ring is the way tests weaknesses posterior wall ingvinal channels. Laparoscopy can also be reached by opening a small window on the peritoneum and observing posterior wall
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