![]() ![]() To look at the effectiveness of EST, a review of all cases from December 2007 to December 2017 with and without EST and the recurrence of IH were carried out. The “external squeeze test” (EST) was introduced by the author in 2007, which is a simple on-table assessment tool to test completeness of closure of the PPV using the port-free purse-string technique for laparoscopic inguinal hernia (LIH) repair. Recurrent inguinal hernia (IH) after laparoscopic repair occurs most likely secondary to incomplete closure of the patent processus vaginalis (PPV). Keywords: pediatric, laparoscopy, inguinal hernia, recurrent We highly recommend EST in pediatric laparoscopic hernia repair, especially in large PPV. All the recurrences were re-repaired laparoscopically.Ĭonclusion: EST is a simple, useful on-table assessment tool which significantly detects completeness of closure of PPV which may prevent recurrence of IH. There were five recurrences of PPVs consistent with recurrent IH (0.57%) one was in a patient with negative EST, attributed to a slipped ligature the other four did not have EST performed ( p<0.000000). Results: A total of 874 PPVs were repaired. All patients had 1- to 12-month follow-up. A complete closure of PPV would not produce any bubbles internally upon external pressure this would be taken as a negative EST. If the closure was incomplete, EST would result in escape of CO 2 from within the scrotum or labia back into the peritoneal cavity, visualized as air bubbles internally and taken as a positive EST. ![]() Closure of PPV was achieved with creation of purse string over pre-peritoneal fascia of the deep inguinal ring with avoidance of important structures EST was then performed, that is, a gentle squeeze on the scrotum or labia majora while the telescope remains focused at the pursed area. Patients and methods: A review of effectiveness of EST and recurrence of IH was carried out at our institution from December 2007 to December 2017. ![]() The “external squeeze test” (EST) is a simple on-table assessment tool to check completeness of closure of PPV during laparoscopic IH repair. Dayang Anita Abdul Aziz, 1 Marjmin Osman, 1 Felicia Lim, 2 Rufina Teo, 2 Zarina Abdul Latiff, 3 Rizal Abdul Manaf 4ġDepartment of Surgery, UKM Medical Centre, Kuala Lumpur, Malaysia 2Department of Anaesthesia, UKM Medical Centre, Kuala Lumpur, Malaysia 3Department of Paediatrics, UKM Medical Centre, Kuala Lumpur, Malaysia 4Department of Public Health, UKM Medical Centre, Kuala Lumpur, Malaysiaīackground: In pediatric patients, recurrent inguinal hernia (IH) after laparoscopic repair mostly occurs secondary to incomplete closure of the patent processus vaginalis (PPV). ![]()
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