title: Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study.
abstract: OBJECTIVE
  We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population.
  
  
  METHODS
  Twenty-eight rabbits were divided in 2 groups: group I (female morphology) - persistence of the peritoneal-vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) - persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2-0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation.
  
  
  RESULTS
  Ultrasound allowed characterization of inguinal-crural structures. Group I - complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II - complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged.
  
  
  CONCLUSIONS
  Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair.
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Hospital de Dona Estefânia Hospital de Dona Estefânia, Serviço de Cirurgia Pediátrica, Rua Jacinta Marto, 1169-045 Lisbon, Portugal. Electronic address: pedro.pires@chlc.min-saude.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Reino-Pires
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Pêgo
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal.
authors.forename: Alice
authors.initials: A
authors.lastname: Miranda
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Department of Paediatric Surgery, Hospital de Braga, 4710-243, Braga, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Barroso
authors.affiliation: Hospital de Dona Estefânia Hospital de Dona Estefânia, Serviço de Cirurgia Pediátrica, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: España
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; Department of Paediatric Surgery, Hospital de Braga, 4710-243, Braga, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
mesh_terms: D000818:Animals; D002648:Child; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008026:Ligation / Q000379:methods; D008297:Male; D023421:Models, Animal; D010537:Peritoneum / Q000601:surgery; D011817:Rabbits; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Laparoscopy; Minimally invasive; Rabbits; Surgery; Ultrasound