**10.4 SIPES inguinal herniorrhaphy**

*Pediatric Surgery, Flowcharts and Clinical Algorithms*

cholecystectomy performed by trainees in patients with hematological disease. We conducted a retrospective study to determine the feasibility, safety, and expediency of SIPES cholecystectomy performed by trainees. 45 patients underwent SILS cholecystectomy. Age of the patients ranged from 7 to 16 years. Hematological disease were in >80% of cases. One extra port was needed in 2 patients in the beginning of the series. Eight procedures were done simultaneously, six splenectomy, one appendectomy, and one herniotomy, and were excluded from MOT. No conversion was needed. No wound infection. MOT is 85 ± 40 min. (**Figures 6** and **7**). It is

• We made a new technique for gallbladder traction by using a curved needle which visualize Calot's

**Procedures Age OT (min) # Conversion**

7–16 85 ± 40 52 2 (extra

port)

comparable with conventional technique.

Cholecystectomy (one with inguinal hernia

repair + 1 with appendectomy)

• SIPES cholecystectomy is the second common operation in our center.

**150**

**Summary**

**Figure 7.**

**Figure 6.**

*SIPES cholecystectomy 6 months post-op.*

*SIPES cholecystectomy MOT.*

triangle clearly.

The approach to inguinal hernia in the pediatric population has historically been via an open technique. During recent years, laparoscopic surgery has emerged as an alternative in the treatment of pediatric inguinal herniorrhaphy. Different laparoscopic technique has been used, and SIPES is a recommended approach for management of inguinal herniorrhaphy [28]. SIPES inguinal herniorrhaphy gives opportunity to explore the contralateral side. We retrospectively review all SIPES inguinal hernia cases. MOT, intra- and postoperative complications, cosmetic results, and contralateral patencies of processus vaginalis (CPPV) were recorded. Patients were followed up for 4 months postoperatively. A total of 46 patients were operated, 39 (84.8%) were male, and 7 (15.2%) were female. Right side inguinal hernias were 18 (39.1%), left were 12 (26.1%), and bilateral sides were 16 (34.8%). 56.5% were less than 1 year, 19.6% were between 1 and 5 years, and 23.9% were 6–13 years old. Mean age is 2.7 years. For unilateral procedures MOT was 27 min. For bilateral procedures MOT was 40 minutes. Seven (23%) (CPPV) was found in laparoscopic surgery. Stitch granuloma developed in one patient.

#### **Summary**

• PIRS is comparable with OH.

• It needs good ancillary services for babies below 6 months of age.

