Laparoscopic Repair of Pediatric Inguinal Hernia: Disconnection of

the Hernial Sac versus Sac Excision at Suez Canal University

Hospitals, Ismailia.

A Thesis protocol submitted in partial fulfillment of the requirements of

Master’s degree in General Surgery

By
Mostafa Sameh Ahmed El Deep
M.B.B.Ch., (2021)
Resident of Pediatric Surgery,
Faculty of Medicine, Suez Canal University

Supervisors:
Title Name Job Title University
Prof. Tarek Abdulazim Professor of Pediatric Faculty of
Dr. Gobran - Surgery Medicine -
Zagazig
University
DR. Ahmed Sobh Ahmed Lecturer of Pediatric Faculty of
darwish surgery Medicine, Suez
Canal University
DR. Ahmed Mahmoud Lecturer of Pediatric Faculty of
Moubarak surgery Medicine, Suez
Canal University

Faculty of Medicine
Suez Canal University
2024
 Faculty of medicine
“Thesis Research Protocol”

Student Name: Mostafa Sameh Ahmed Student ID:

El Deep

Submission Date:

Degree: ☒ M.Sc. ☐ PH.D.

Department: General Surgery

Laparoscopic Repair of Pediatric Inguinal Hernia:

Thesis Title in Disconnection of the Hernial Sac versus Sac
English: Excision at Suez Canal University Hospitals,
Ismailia.

‫ فصل كيس الفتق‬:‫إصالح الفتق اإلربي بالمنظار لدى األطفال‬

Thesis Title in
‫ اإلسماعيلية‬،‫مقابل استئصال الكيس في مستشفيات جامعة قناة السويس‬
Arabic:

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1
 ABSTRACT
Introduction: Many techniques have been described for the treatment of
pediatric inguinal hernia (PIH). Some authors emphasized the
importance of disconnecting the sac, to create a scar, and to close the
peritoneum mimicking the open approach. Others stated that peritoneal
disconnection alone is enough for treatment of PIH regardless of the size
of the internal ring.
Aim of the study: To compare the short-term outcomes of laparoscopic
hernial sac disconnection and closure without sac excision against
hernial sac excision children in terms of feasibility, surgical details,
recurrence rate, and postoperative complications
Materials and methods:
The study will be carried from July 2024 to March 2025, on 34 patients
with Inguinal Hernia in each group. Patients will be randomly divided
into two groups: group A, subjected to laparoscopic hernial sac
disconnection and closure without sac excision and group B, subjected
to laparoscopic hernia sac disconnection with hernial sac excision. Both
groups will be compared regarding the operative details, including
complications and conversion, postoperative complications and
recurrence.
Expected Outcomes: Evaluation of the most effective technique to
repair hernias in children which will help to improve operative time and
reduce intra & postoperative complications.
Keywords: laparoscopic, pediatric, hernia repair, sac disconnection

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2
 Introduction and Background

Pediatric inguinal hernias (PIH) are a prevalent surgical condition,

accounting for 15% of pediatric surgery practice. Conventional open
repair of inguinal hernias has been acknowledged as the gold standard
treatment for PIH due to its decreased morbidity, good cosmesis, and
lower recurrence rates. However, during the last two decades, as pediatric
minimal invasive surgery (MIS) has advanced, laparoscopy has become
more popular for the treatment of PIH. (Petridou et al., 2023)
Congenital (indirect) inguinal hernias occur in 2% to 5% of full-term
neonates, with a ratio of male to female of 4.2: 1. (Jessula S, 2018). The
incidence in preterm infants is substantially higher and is gestational age
dependent, ranging from 9% to 11% and approaching 60% in extremely
low birth weight infants. At clinical presentation, 60% of hernias occur
on the right side, 25% to 30% on the left, and 10% to 15% are bilateral.
(Chang SJ, et al. 2016)
Laparoscopy has numerous advantages over open surgery, including
magnification, identification of contralateral patent processes vaginalis
(CPPV) and other types of hernia, the best option for recurrent hernia,
and little manipulation of the vas deferens and testicular arteries.
(Mohammad et al., 2018)

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3
 Open inguinal hernia repair can be performed under caudal block or
laryngeal mask anesthesia, however laparoscopic surgery requires
controlled general anesthesia and endotracheal intubation. Also,
throughout the learning curve, laparoscopic surgery takes longer than
open repair. (Shehata et al., 2018)
However, it has not attained the widespread acceptability observed
with other treatments, such as laparoscopic cholecystectomy, which may
be related to concerns that recurrence rates are higher than those for open
surgery, offsetting any possible benefits. (Raveenthiran & Agarwal.
2017)
Several procedures have been documented, including the use of extra-
or intracorporeal knotting and high ligation with or without peritoneal
disconnection at the internal ring. The intra-corporeal procedure involves
closing the internal ring with an intra-corporeal suture, typically using
three ports. The extra-corporeal approach employs a number of trocars,
ranging from one to three, together with a pre-peritoneal suture.
(Elbatarny et al., 2020)
Laparoscopic disconnection of the hernial sac with peritoneal closure
and sac excision over the internal ring was reported as a way to
replicate the open procedure and reduce the likelihood of recurrence.
(Bin Nour et al., 2023)
Disconnecting the hernial sac without sac excision is a successful
treatment for hernias with a small internal ring diameter (IRD) of less
than 10 mm, according to certain publications. Others concluded that
disconnection without sac excision is effective in larger rings of up to
20 mm, regardless of the interior ring size. (Nour et al., 2023)

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4
 The reason behind conducting this study is to compare the short-term
outcomes of laparoscopic hernial sac disconnection and closure without
sac excision against hernial sac excision children in terms of feasibility,
surgical details, recurrence rate, and postoperative complications

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5
 Research question:

• Are there differences between laparoscopic repair of inguinal

hernia with Disconnection of the Hernial Sac versus Sac Excision?
Research Hypothesis, Aim, Objectives & Expected Outcomes
Hypothesis
• There are differences between laparoscopic repair of inguinal
hernia with Disconnection of the Hernial Sac versus Sac Excision

Null hypothesis:
• There are no differences between laparoscopic repair of inguinal
hernia with Disconnection of the Hernial Sac versus Sac Excision

Aim
• To compare the short-term outcomes of laparoscopic hernial sac
disconnection and closure without sac excision against hernial sac
excision children in terms of feasibility, surgical details,
recurrence rate, and postoperative complications
Objectives

Primary objective:
• To evaluate the effectiveness of laparoscopy in the treatment of
inguinal hernias among pediatrics including technical
refinements and operative time.

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6
 Secondary objectives:

• To evaluate the safety of laparoscopy in the treatment inguinal hernia

among pediatrics including intra-operative and post-operative
complications.

• To assess the recurrence rate after laparoscopic repair of inguinal hernia

among pediatrics.

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7
 Research Design and Methods

Study design:

• This will be a prospective randomized clinical study. The

randomization will be carried out by the closed sealed envelope
method.
Study setting:

• Study will be conducted at Pediatric Surgery unit of Suez Canal

University Hospital, Ismailia, Egypt.

Study population:

• The study population will include all patients with inguinal

hernias came to pediatric surgery outpatient clinics of Suez Canal
University Hospital during the study period.

All patients will be enrolled to participate in the current study and each
parent or legal guardians will sign written consent
Sampling technique:
It will be consecutive sampling.

Inclusion criteria:

• Infants and children with Inguinal Hernia with an age range

from 1 month to 12 years.

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 Exclusion criteria:
• Infants and children with: incarcerated PIH, recurrent PIH,
patients with undescended testis, patients with chronic
comorbidity—such as congenital heart disease and severe chest
troubles—and patients with chronic cough or chronic
constipation.

Expected Outcomes

Evaluation of the most effective technique to repair hernias in

children which will help to improve operative time and reduce
intra & postoperative complications.

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9
 Statistical plan
Sample size:

The sample size is determined using the following equation:

(Charan & Biswas, 2013)

Were

• n= sample size
• Z α/2 = 1.96 (The critical value that divides the central 95% of
the Z distribution from the 5% in the tail)
• p = Prevalence of Congenital Hernia in Egypt = 5%
(Jessula S, et al., 2018)

• E = margin of error/ width of confidence interval = 80%

• Therefore, the calculated sample size will be 31 subjects;
however, after adding the expected (drop-out) rate (10%), the
final sample size will be 34 subjects each group.
It will be divided into 2 groups:
group A: subjected to laparoscopic hernial sac disconnection and
closure without sac excision
group B: subjected to laparoscopic hernia sac disconnection with sac
excision

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 Data Collection:
All patients will be subjected to the following:
Structured interview-based Questionnaire: will be used after obtaining
informed consent from each parent or legal guardians.

*pre-operative assessment:
Data will be collected from all patients using a simple self-designed
questionnaire by the researcher and the pre-operative data collected
included:
• Name, age and gender.
• Type of the hernia
• History of previous operations, and history of recurrence.
• Physical examination of the hernia.
• Exclusion of other congenital anomalies.
• Complete blood count, INR and PTT.
• US to detect the size of the defect and measure the contralateral side
ring. (A contralateral ring with width more than 5 mm is considered
patent processus vaginalis and will be compared with the surgical
findings).
*Procedure: -
-Anesthesia and preparation:
Patients are kept Nil by mouth for at least 6 hours prior to the surgery
except for breast feeding (4 hours) and clear liquids (2 hours). All
patients will have general anesthesia. Induction is done by inhalation of
Sevoflurane with a secured IV line. Then intubation with appropriate
ETT is done. Then O2 and Isoflurane inhalation are given. Muscle
relaxant is given with controlled ventilation. Third generation
cephalosporin is given intravenously as a 50mg/kg bolus before the start.
Caudal regional anesthesia with Bupivacaine is used.

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11
 -Position and ergonomics:
The surgeon is positioned at the head of the patient, and the camera
operator is contralateral to the side of pathology. The video column is
positioned at the patient’s feet. The patient is placed in a supine position
with a 15°– 20° Trendelenburg inclination of the operative table to reduce
the abdominal contents. The average intra-abdominal pressure is 6–8
mmHg in patients under 1 year of age and 8–10 mmHg in older children.
The bladder will be emptied before beginning of the operation. Patients
under 1 year of age are placed trans table position for a better work
ergonomics.

-Steps:
1- One 5-mm trocar is inserted through the umbilicus. Through this
trocar, a 30-degree angled laparoscope is placed and a pneumoperitoneum
is maintained at 8–10 mmHg with a CO2 flow rate of 1– 2 L/min.
2- Bilateral internal inguinal rings are checked carefully for assurance of
indication and exploring the competence of the other inguinal ring.
3- Two further 3-mm trocars are inserted through separate stab incisions
in the lateral border of the rectus muscles at midclavicular lines.
4- The dissection started by using a dissector and scissors. The sac is
everted and the initial cut is done above the internal inguinal ring in the
parietal peritoneum.
5- Then, the dissection is carried out by separating the hernia sac from the
vascular structures and the vas in males.
6- The needle of the suture is inserted inside of the abdominal cavity
through right side trocar by laparoscopic needle holder with 3-0 Vicryl.
7- A purse-string suture is placed as in the peritoneum at the level of the
internal inguinal ring taking only the peritoneum leaving the distal sac
remnant in-situ.
8- In larger hernias (>4-5mm), add one or more interrupted stitches
between the conjoined tendon and crural arch to narrowing the internal
ring.
9- The same steps will be repeated in the contralateral internal inguinal
ring in case of bilateral inguinal hernia.

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12
 *Intraoperative data collection:
1- Presence of contralateral patent processus vaginalis.
2- Injury to any vital structure.
3- Name of the operator.
4- Time of the surgery approximated in minutes (any time more than 30
seconds is added as a minute).
*Post-operative recovery:
Patients are starting oral feeding of soft diet 2 hours after complete
recovery and they are discharged home after 4 hours.
*Post-operative follow-up:
Follow up is done for 6 months.
1- The first visit will be 7 days postoperative.
2- The second visit will be 30 days postoperative.
3- A third visit will be after 3 months and a last visit by the 6th month.
*During the follow up period we detect any of the following:
• Hematoma of the testis or the cord. (Early complication)
• Edema of the testis or the cord. (Early complication)
• Recurrence. (Late complication)
• Hydrocele. (Late complication)
• Port-site hernia. (Late complication)
• Testicular atrophy. (Late complication)
• Ascending testis. (Late complication)

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 Data analysis:
• Statical analysis will be performed using the statistical package
for the Social Sciences (SPSS) program.
• Data will be presented as tables and graphs as appropriate.
• Quantitative data will be expressed as mean and standard
deviation while qualitative data will be expressed as number and
percentage.
• Comparisons will be performed using T test (for quantitative
data) and chi square (for qualitative data).
• Significance will be considered at p value of < 0.05.

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14
 Ethical consideration:
* Data are collected after permission of the responsible authorities; Chief
of Surgery Department, Chief of Clinical Department and Ethics
committee.
• Written informed consent is obtained from all parents, or legal
guardians, after full explanation of hazards and benefits of the
management procedures that will be performed for each patient before
starting field work.
• Patients‟ guardians are notified about the study and the informative
written consent will be obtained prior to participation in the study.
• The aim of the study and the methods used in the research, possible
complication and other surgical options are reviewed with each patient
prior to participation.
• Confidentiality of the patients are maintained through the duration of
the research.
• Any patient refuses to participate in the study will not be enrolled in the
study (but surgical intervention will be done without including the results
in the study).
• Personal data of the participants are secretly treated.
• Patients are provided written consent for the use of their images.
• The patient has the right to withdraw from the study at any time with
neither jeopardizing the right of the patient to be treated nor affecting the
relationship between the patient and care provider.
• There are no similar researches currently going on in the Surgery
Department.

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 Time Plan

May Jun July Aug Sep Oct Nov Dec Jan Feb March
Item
2024 2024 2024 2024 2024 2024 2024 2024 202 2024
2024 4

Protocol
writing

Literature
review

Data collection

Data analysis

Thesis
preparation

Review &
Thesis
presentation

Research Estimated Budget

Items Cost by Egyptian bounds
Software 1000
Materials 20000
Publications 10000
Total 31000

The research costs will be encored on the researcher himself

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 References:
• Bin Nour, S. M., Rozeik, A. E., Alekrashy, M., & El-Taher, A.
K. (2023). Laparoscopic techniques for congenital inguinal hernia
repair. Journal of Pharmaceutical Negative Results, 14(3).
• Chang SJ, Chen JYC, Hsu CK, et al. (2016) The incidence of
inguinal hernia and associated risk factors of incarceration in
pediatric inguinal hernia: a nation-wide longitudinal population-
based study. Hernia.; 20:559–563.
• Charan, J. and Biswas, T. (2013), “How to Calculate Sample Size
for Different Study Designs in Medical Research?”, Indian Journal
of Psychological Medicine, Indian Psychiatric Society South Zonal
Branch, Vol. 35 No. 2, p. 121.
• Elbatarny, A. M., Khairallah, M. G., Elsayed, M. M., & Hashish,
A. A. (2020). Laparoscopic repair of pediatric inguinal hernia:
disconnection of the hernial sac versus disconnection and peritoneal
closure. Journal of Laparoendoscopic & Advanced Surgical
Techniques, 30(8), 927-934.
• Jessula S, Davies DA. (2018) Evidence supporting laparoscopic
hernia repair in children. Curr Opin Pediatr.; 30(3):405-10.
• Mohammad, G., Mostafa, M., HASHISH, A. A., & AKRAM,
M. E. (2018). Laparoscopic Repair of Pediatric Inguinal Hernia by
Disconnection of the Hernial Sac. The Medical Journal of Cairo
University, 86(September), 3223-3229.
• Nour, S. M. B., Rozeik, A. E., Alekrashy, M., & El-Taher, A. K.
(2023). Laparoscopic Pediatric Inguinal Hernia Repair with and
without Excision of the Hernial Sac. The Egyptian Journal of
Hospital Medicine, 90(2), 2520-2525.
• Petridou, M., Karanikas, M., & Kaselas, C. (2023).
Laparoscopic vs. laparoscopically assisted pediatric inguinal hernia
repair: a systematic review. Pediatric Surgery International, 39(1),
212.
• Raveenthiran, V., & Agarwal, P. (2017). Choice of repairing
inguinal hernia in children: open versus laparoscopy. The Indian
Journal of Pediatrics, 84, 555-563.
• Shehata, S. M., Attia, M. A., Attar, A. A. E., Ebid, A. E.,
Shalaby, M. M., & ElBatarny, A. M. (2018). Algorithm of
laparoscopic technique in pediatric inguinal hernia: results from

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17
 experience of 10 years. Journal of Laparoendoscopic & Advanced
Surgical Techniques, 28(6), 755-759.

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18
 11. Appendices:
Study Questionnaire: -
Contact information
Name:
Age: Parent mobile:
Residency: Gender: Male Female
Preoperative assessment
Type: Bilateral Recurrent
Congenital anomalies: Yes No
Intraoperative data
Contralateral hernia: Yes No
Injury: Yes No
Operative time: minutes
Postoperative follow-up
No complications Edema Hematoma Recurrence

Port-site hernia Hydrocele Ascending testis Testicular atrophy

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19
 ‫نموذج الموافقة المستنيرة ألجراء بحث‬
‫طبي على مشارك متطوع‬

‫‪.‬‬ ‫النوع‬ ‫‪.‬‬ ‫االسم‬

‫‪.‬‬ ‫تاريخ الميالد‬ ‫‪.‬‬ ‫السن‬

‫عنوان البحث‪:‬‬
‫إصالح الفتق اإلربي بالمنظار لدى األطفال‪ :‬فصل كيس الفتق مقابل استئصال الكيس في‬
‫مستشفيات جامعة قناة السويس‪ ،‬اإلسماعيلية‬
‫الخلفية العلمية والهدف من أجراء البحث‪:‬‬
‫الفتق اإلربي عند األطفال (‪ )PIH‬هو حالة جراحية منتشرة‪ ،‬وهو ما يمثل ‪ ٪15‬من ممارسة جراحة األطفال‪ .‬تم‬
‫االعتراف باإلصالح المفتوح التقليدي للفتق اإلربي باعتباره العالج القياسي الذهبي لـ ‪ PIH‬نظ ًار النخفاض معدل اإلصابة بالمرض‪،‬‬
‫والتجميل الجيد‪ ،‬وانخفاض معدالت التكرار‪ .‬ومع‬
‫ذلك‪ ،‬خالل العقدين الماضيين‪ ،‬مع تقدم جراحة التدخل الجراحي البسيط لدى األطفال (‪،)MIS‬‬
‫أصبح تنظير البطن أكثر شيو ًاعلعالج فرط التصبغ األولي‪.‬‬
‫يحدث الفتق اإلربي الخلقي (غير المباشر) في ‪ %2‬إلى ‪ %5‬من الولدان الناضجين‪ ،‬مع نسبة‬
‫الذكور إلى اإلناث ‪ .1 :4.2‬يعد معدل اإلصابة عند الخدج أعلى بكثير ويعتمد على عمر الحمل‪،‬‬
‫‪ ٪60‬عند الرضع منخفضي وزن الوالدة للغاية‪ .‬في‬ ‫‪ ٪11‬ويقترب من‬ ‫ويتراوح من ‪ ٪9‬إلى‬
‫المظاهر السريرية‪ ،‬يحدث ‪ %60‬من حاالت الفتق في الجانب األيمن‪ ،‬و‪ %25‬إلى ‪ %30‬على‬
‫الجانب األيسر‪ ،‬و‪ %10‬إلى ‪ %15‬في الجانب األيسر‪.‬‬
‫الفوائد المتوقعة من البحث‪:‬‬
‫• تقييم التقنية األكثر فعالية إلصالح الفتق عند األطفال والتي ستساعد على تحسين وقت العملية‬
‫وتقليل المضاعفات أثناء وبعد العملية الجراحية‪.‬‬
‫المخاطر المحتمل حدوثها من اجراء هذا البحث‪:‬‬
‫ال توجد مخاطر سلبية محتمل حدوثها جراء تلك الدراسة‪.‬‬
‫البدائل المتاحة‪ :‬في حالة رفضك االشتراك في هذا البحث ستتلقى عالجك المعتاد‪ .‬سرية المعلومات‪ :‬سوف‬
‫تعامل معلوماتك بسرية كاملة ولن يطلع على بياناتك سوى الباحث الرئيسي‪ .‬بعد انتهاء الدراسة سيتم إبالغك بنتائج البحث كما سيتم‬
‫إبالغك بأي نتائج تتعلق بحالتك‬
‫الصحية خاصة‪.‬‬

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‫‪20‬‬
 ‫حقك في االنسحاب‪ :‬من حقك االنسحاب من البحث في أي وقت دون ابداء أسباب دون أي‬
‫عواقب سلبية عليك‪.‬‬
‫‪:‬عند وجود أي استفسار لديك يمكنك االتصال ب‬
‫التليفون‪:‬‬ ‫اسم الباحث الرئيسي‪ :‬مصطفى سامح أحمد‬
‫التليفون‪:‬‬ ‫مقر لجنة األخالقيات‪ :‬كلية الطب جامعة قناة السويس‬

‫أقر أنني أطلعت وفهمت االجراءات التي ستتم من خالل هذا البحث ووافقت عليها‬
‫‪.‬‬ ‫الباحث الرئيسي‬ ‫‪.‬‬ ‫المشارك في البحث‬
‫االسم‪:‬‬
‫التوقيع (البصمة)‪:‬‬
‫التاريخ‪:‬‬
‫ملحوظة‪:‬‬
‫‪-1‬من حقك الحصول على صورة من اإلقرار‪.‬‬
‫‪-2‬هذا البحث توطئة لرسالة الدكتوراه‪.‬‬
‫تمت الموافقة على هذا البحث من قبل لجنة أخالقيات البحوث الطبية ‪..................‬‬
‫بتاريخ ‪ .....................‬هذه الموافقة سارية حتى‬
‫خاتم اللجنة‬ ‫‪:‬رئيس اللجنة‪:‬‬

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‫‪21‬‬
 ‫شششش شششششش‬

‫إصالح الفتق اإلربي بالمنظار لدى األطفال‪ :‬فصل كيس الفتق‬

‫مقابل استئصال الكيس في مستشفيات جامعة قناة السويس‪ ،‬اإلسماعيلية‬

‫خطة بحث مقدمة توطئة للحصول على درجة‬

‫ماجستير في الجراحة العامة‬
‫مقدمة من‬
‫الطبيب‪/‬‬
‫مصطفى سامح أحمد‬
‫بكالوريوس الطب والجراحة‬
‫طبيب مقيم جراحة األطفال‪ ،‬كلية الطب‪ ،‬جامعة قناة السويس‬
‫المشرفين‬
‫الجامعة‬ ‫الوظيفة‬ ‫االسم‬ ‫اللقب‬
‫كلية الطب ‪ -‬جامعة‬ ‫أستاذ جراحة األطفال‬ ‫طارق عبد العظيم جبران‬ ‫أستاذ‬
‫الزقازيق‬
‫كلية الطب جامعة قناة‬ ‫مدرس جراحة األطفال‬ ‫أحمد صبح أحمد درويش‬ ‫مدرس‬
‫السويس‬

‫كلية الطب جامعة قناة‬ ‫مدرس جراحة األطفال‬ ‫أحمد محمود مبارك‬ ‫مدرس‬
‫السويس‬

‫كلية الطب جامعة قناة‬

‫السويس‬
‫‪٢٠٢٤‬‬
 ‫الملخص العربي‬
‫المقدمة‪:‬‬
‫الفتق اإلربي عند األطفال (‪ )PIH‬هو حالة جراحية منتشرة‪ ،‬وهو ما يمثل ‪ ٪15‬من ممارسة جراحة األطفال‪ .‬تم‬
‫االعتراف باإلصالح المفتوح التقليدي للفتق اإلربي باعتباره العالج القياسي الذهبي لـ ‪ PIH‬نظ ًار النخفاض معدل اإلصابة بالمرض‪،‬‬
‫والتجميل الجيد‪ ،‬وانخفاض معدالت التكرار‪ .‬ومع‬
‫ذلك‪ ،‬خالل العقدين الماضيين‪ ،‬مع تقدم جراحة التدخل الجراحي البسيط لدى األطفال (‪،)MIS‬‬
‫أصبح تنظير البطن أكثر شيو ًاعلعالج فرط التصبغ األولي‪.‬‬
‫يحدث الفتق اإلربي الخلقي (غير المباشر) في ‪ %2‬إلى ‪ %5‬من الولدان الناضجين‪ ،‬مع نسبة‬
‫الذكور إلى اإلناث ‪ .1 :4.2‬يعد معدل اإلصابة عند الخدج أعلى بكثير ويعتمد على عمر الحمل‪،‬‬
‫‪ ٪60‬عند الرضع منخفضي وزن الوالدة للغاية‪ .‬في‬ ‫‪ ٪11‬ويقترب من‬ ‫ويتراوح من ‪ ٪9‬إلى‬
‫المظاهر السريرية‪ ،‬يحدث ‪ %60‬من حاالت الفتق في الجانب األيمن‪ ،‬و‪ %25‬إلى ‪ %30‬على‬
‫الجانب األيسر‪ ،‬و‪ %10‬إلى ‪ %15‬في الجانب األيسر‪.‬‬
‫يتميز تنظير البطن بالعديد من المزايا مقارنة بالجراحة المفتوحة‪ ،‬بما في ذلك التكبير‪ ،‬وتحديد‬
‫العمليات المهبلية المقابلة (‪ )CPPV‬وأنواع أخرى من الفتق‪ ،‬وهو الخيار األفضل للفتق المتكرر‪،‬‬
‫والقليل من التالعب باألسهر وشرايين الخصية‪.‬‬
‫الهدف من البحث‪:‬‬
‫• تقييم التقنية األكثر فعالية إلصالح الفتق عند األطفال والتي ستساعد على تحسين وقت العملية‬
‫وتقليل المضاعفات أثناء وبعد العملية الجراحية‪.‬‬
‫خطة البحث ومنهجية الدراسة‪:‬‬
‫• تصميم الدراسة‪ :‬ستكون هذه دراسة سريرية عشوائية مستقبلية‪ .‬سيتم تنفيذ التوزيع‬
‫العشوائي بطريقة المظروف المغلق‪.‬‬
‫سيتم إجراء الدراسة في وحدة جراحة األطفال بمستشفى جامعة قناة‬ ‫• موقع البحث‪:‬‬
‫السويس‪ ،‬اإلسماعيلية‪ ،‬مصر‬
‫• دراسة السكان‪ :‬سوف يشمل مجتمع الدراسة جميع مرضى الفتق اإلربي الذين وردوا‬
‫إلى العيادات الخارجية لجراحة األطفال بمستشفى جامعة قناة السويس خالل فترة‬
‫الدراسة‪.‬‬

‫‪Tel: + 01555837132‬‬ ‫‪E-mail: mostafaasameh46@gmail.com‬‬

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