Investigation of the reliability of the laparoscopic PIRS (Percutaneous Internal Ring Suturing) technique in babies with inguinal hernia in the first three months of life

Investıgatıon of the relıabılıty of the laparoscopıc PIRS (Percutaneous Internal Rıng Suturıng) technıque ın babıes wıth ınguınal hernıa ın the fırst three months of lıfe Aim: Inguinal hernia is one of the leading childhood pathologies requiring surgical treatment worldwide. Its incidence increases as the age of birth decreases, and it can be seen 4 times more frequently in premature and low birth weight male babies. With developing technology and surgical techniques, laparoscopic surgery is frequently used in inguinal hernia surgery as in most pathologies. Many laparoscopic surgical methods have been defined in inguinal hernia repair. The most commonly used of these methods is the PIRS (Percutaneous Internal Ring Suturing) method. This study aims to show that the PIRS technique used in inguinal hernia repair can be used safely with laryngeal mask anesthesia (LMA) in infants 3 months of age and younger, to evaluate the operative times, hospitalization times, preoperative and postoperative data, recurrence development and complications of the classical open surgery method and the PIRS method, to examine both methods with their advantages and disadvantages, and to present recommendations based on current data for pediatric surgeons. Material and Methods: Data of 59 patients who underwent surgery for inguinal hernia in our clinic between September 2022 and September 2023 and were younger than 3 months old were retrospectively reviewed. PIRS was performed as a laparoscopic method and classical open surgery was performed as open surgery. Anesthesia was administered to the patients via intratracheal or laryngeal mask. Patients with hydrocele, undescended testicle, or incarcerated hernia requiring emergency surgery were excluded from the study. Results: Of the patients, 26 were operated with laparoscopic PIRS method and 33 were operated with open method. 76.9% (n: 20) of the patients were male, 23.1% (n: 6) were female and the mean age was 71 days. Demographically, both groups were found to have similar characteristics. In our study, the rate of bilaterality in cases undergoing laparoscopic surgery was found to be approximately 2.8 times higher than in open surgery. In addition, the rate of LMA use for anesthesia in both groups was found to be similar. Among the parameters evaluated, a statistically significant difference was found between the two groups in terms of bleeding in the bladder and muscle relaxant requirement. When the other parameters examined in our study, namely hospital stay, feeding time, operation time, swelling, scrotal edema, wound infection, postoperative 30th minute blood sugar, postoperative stridor and bronchospasm development, complication development and recurrence development parameters were evaluated, no statistically significant difference was found. Conclusion: When the findings in our study and the current literature were examined, it was seen that PIRS repair was at least as effective and safe as open repair when compared to open surgery. We believe that PIRS method will be the preferred treatment option in the future for inguinal hernia repairs because it has advantages such as being minimally invasive compared to open surgery, excellent wound healing, and allowing the contralateral groin to be evaluated and an occult hernia to be repaired if detected. It was also seen that PIRS method can be performed safely with LMA in small babies. Key words: Inguinal hernia, laparoscopy, PIRS, child