A 12-year-old Jiangsu child, Xiao Qiang (pseudonym), had a “pigeon egg” bulging from time to time at the root of his lower abdomen and thighs. He was diagnosed with an inguinal hernia. The parents consulted relevant information on their own and made more inquiries, and found Dr. Zhang Qiang’s group.
Dr. Bao Yuke, the chief expert with more than 10 years of clinical experience in hernia surgery, examined the hernia and found that it was the size of a fist and that there was an occult hernia on the opposite side.
After thorough evaluation, design and communication, a hernoscopy (hernioscopy) was performed for the child’s specific condition. A medical search confirmed that this was the first clinical application of hernioscopy in China.
The surgery was performed under sedation-assisted local anesthesia, and the patient slept peacefully to the sound of music. The surgical incision was chosen in a concealed location in the lower abdomen, only one finger wide, just wide enough for two mosquito forceps to operate.
(Less than 2 cm incision for pediatric inguinal hernia surgery)
However, a duck egg sized bag was dragged out of such a small hole, which Dr. Bao said was the hernia sac.
(Inguinal hernia hernial sac)
The bilateral surgery was completed within a quarter of an hour
A special endoscope entered the child’s abdominal cavity through the opening on the hernia sac, and the contralateral hiatal hernia was re-diagnosed under direct vision and cured by high ligation of the hernia sac. In just about ten minutes, a bilateral inguinal hernia surgery was completed, but it was a historic surgery because it was the first hernoscopic surgery in China.
(Animation of hernoscopic surgery)
Home on the day of surgery
The child walked on his own after surgery and ate lunch. After 3 hours of post-operative observation, the patient’s family went home happily on the same day after confirming that he had urinated on his own with no obvious pain.
Knowledge: Hernoscopic surgery
Pediatric inguinal hernias are common, with 15% of them occurring bilaterally at the same time, and about 8% of patients will develop a hernia on the opposite side after one side has been cured. Because the etiology of pediatric inguinal hernia is mainly congenital unattachment of the sphincter and there is no real abdominal wall defect, routine surgery is performed by simply performing a high ligation of the hernia sac.
Clinically, children with giant inguinal hernias or those with a developed abdominal wall have a high recurrence rate after simple high ligation of the hernia sac. In these high-risk patients, additional abdominal wall tissue repair is required to ensure efficacy. The surgeon therefore needs to develop an individualized surgical plan based on the patient’s condition.
(endoscopic placement of the hernia sac from one side)
In the past, surgery for pediatric inguinal hernia has been divided into two main categories: open surgery and laparoscopic surgery. Open surgery is still the main surgical approach, with the advantage of allowing tissue repair while ligating the hernia sac in a high position, and the disadvantage that only unilateral inguinal hernias can be treated. Laparoscopic surgery is a rapidly developing technique in the last decade or two, which has the advantage of treating bilateral inguinal hernias simultaneously without dissecting the inguinal canal, and the disadvantage that it is difficult to perform abdominal wall tissue repair.
After years of practicing open surgery and laparoscopic surgery, it occurred to Dr. Bao that he could draw on the advantages of both procedures and design a surgical approach suitable for minimally invasive treatment of bilateral inguinal hernia in pediatric high-risk patients at the same time. A literature search revealed that the procedure had been reported abroad in 1992 with positive clinical outcomes. However, it is difficult to perform hernoscopic surgery with conventional laparoscopic equipment, so it has not been widely popularized.
(Four-way endoscope with bendable head end)
This time, Dr. Zhang Qiang Group introduced the world’s only four-way 5mm full HD endoscopic device from Olympus. This endoscope with a 90° turnable head end perfectly solves the technical problem of hernoscopy surgery. It is believed that soon this procedure will become one of the routine surgeries for pediatric inguinal hernia, bringing blessings to children with hernia.
(Yuke Bao of hernia surgery and Xuebo Tong of pediatric surgery in the operation)