{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:46:28Z","timestamp":1793835988553,"version":"4.6.1"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV). Methods: The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR). Results: A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p &gt; 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p &lt; 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p &lt; 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p &lt; 0.001). No cases of ReAd and uROR were observed in any of the study groups. Conclusions: PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.<\/jats:p>","DOI":"10.3390\/children11040437","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T10:04:17Z","timestamp":1712311457000},"page":"437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-720X","authenticated-orcid":false,"given":"Zenon","family":"Pogoreli\u0107","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Hospital of Split, Spin\u010di\u0107eva Ulica 1, 21000 Split, Croatia"},{"name":"Department of Surgery, School of Medicine, University of Split, \u0160oltanska Ulica 2a, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Stani\u0107","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Split, \u0160oltanska Ulica 2a, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-6184","authenticated-orcid":false,"given":"Marko","family":"Ba\u0161kovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s Hospital Zagreb, Ulica Vjekoslava Klai\u0107a 16, 10000 Zagreb, Croatia"},{"name":"Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, \u0160alata 3, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/nrurol.2010.80","article-title":"Management of hydrocele in adolescent patients","volume":"7","author":"Cimador","year":"2010","journal-title":"Nat. Rev. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/jum.16380","article-title":"A review of classification, diagnosis, and management of hydrocele","volume":"43","author":"Hoang","year":"2023","journal-title":"J. Ultrasound Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E34","DOI":"10.1055\/s-0035-1555919","article-title":"Common and uncommon presentation of fluid within the scrotal spaces","volume":"1","author":"Patil","year":"2015","journal-title":"Ultrasound Int. Open."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.14712\/18059694.2020.17","article-title":"Hydrocele in pediatric population","volume":"63","author":"Patoulias","year":"2020","journal-title":"Acta Medica (Hradec Kralove)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00383-022-05064-8","article-title":"Laparoscopic management of infantile hydrocele in pediatric age group","volume":"38","author":"Elhaddad","year":"2022","journal-title":"Pediatr. Surg. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1111\/j.1442-2042.2006.01583.x","article-title":"New onset of hydroceles in boys over 1 year of age","volume":"13","author":"Christensen","year":"2006","journal-title":"Int. J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"International Pediatric Endosurgery Group (2010). IPEG guidelines for inguinal hernia and hydrocele. J. Laparoendosc. Adv. Surg. Technol. A, 20, x\u2013xiv.","DOI":"10.1089\/lap.2010.9998"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s10029-017-1715-7","article-title":"Does the laparoscopic treatment of paediatric hydroceles represent a better alternative to the traditional open repair technique? A retrospective study of 1332 surgeries performed at two centres in China","volume":"22","author":"Zhang","year":"2018","journal-title":"Hernia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1016\/j.urology.2015.01.053","article-title":"Application of a laparoscopic, single-port, double-needle technique for pediatric hydroceles with multiple peritoneal folds: A trial from a single-center 5-year experience","volume":"85","author":"Peng","year":"2015","journal-title":"Urology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1089\/end.1994.8.415","article-title":"Laparoscopic repair of pediatric hydroceles","volume":"8","author":"Janetschek","year":"1994","journal-title":"J. Endourol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1007\/s00345-014-1259-8","article-title":"Modified single-port minilaparoscopic extraperitoneal repair for pediatric hydrocele: A single-center experience with 279 surgeries","volume":"32","author":"Wang","year":"2014","journal-title":"World J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s10029-013-1181-9","article-title":"Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: A novel technique","volume":"18","author":"Liu","year":"2014","journal-title":"Hernia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"671301","DOI":"10.3389\/fsurg.2021.671301","article-title":"Laparoscopic vs. open repair surgery for the treatment of communicating hydrocele in children: A retrospective study from a single center","volume":"8","author":"Liu","year":"2021","journal-title":"Front. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"512.e1","DOI":"10.1016\/j.jpurol.2017.03.026","article-title":"Laparoscopic intra-abdominal patent processus vaginalis ligation in pediatric urology practice","volume":"13","author":"Baradaran","year":"2017","journal-title":"J. Pediatr. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1053\/j.sempedsurg.2016.05.006","article-title":"Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era","volume":"25","author":"Esposito","year":"2016","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.kjms.2013.11.006","article-title":"Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children","volume":"30","author":"Alp","year":"2014","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1007\/s00464-018-06611-y","article-title":"Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children","volume":"33","author":"Jukic","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_18","first-page":"2112","article-title":"Quality of life analysis after open and laparoscopic inguinal hernia repair-retrospective study","volume":"55","author":"Srsen","year":"2008","journal-title":"Hepatogastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1080\/08941939.2017.1419317","article-title":"Effects of laparoscopic hernia repair by PIRS (Percutan Internal Ring Suturing) technique on testicular artery blood supply","volume":"32","author":"Oral","year":"2019","journal-title":"J. Invest. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wu, S., Xing, X., He, R., Zhao, H., Zhong, L., and Sun, J. (2022). Comparison of laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure versus open repair for pediatric inguinal hernia. BMC Surg., 22.","DOI":"10.1186\/s12893-022-01787-6"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1089\/lap.2006.16.513","article-title":"Percutaneous internal ring suturing: A simple minimally invasive technique for inguinal hernia repair in children","volume":"16","author":"Patkowski","year":"2006","journal-title":"J. Laparoendosc. Adv. Surg. Technol. A"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s00383-016-3903-4","article-title":"Percutaneous internal ring suturing as a first choice laparoscopic inguinal hernia repair method in girls: A single-center study in 148 patients","volume":"32","author":"Erginel","year":"2016","journal-title":"Pediatr. Surg. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1007\/s00464-020-07457-z","article-title":"Modified percutaneous internal ring suturing with peritoneal injury in children: Matched comparison to open hernia repair","volume":"35","author":"Rao","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2147\/TCRM.S348197","article-title":"Percutaneous Internal Ring Suturing (PIRS)\u2014The Benefits of Laparoscopic Inguinal Hernia Repair","volume":"18","author":"Wolak","year":"2022","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.amjsurg.2016.10.021","article-title":"An institutional analysis of unplanned return to the operating room to identify areas for quality improvement","volume":"214","author":"Lin","year":"2017","journal-title":"Am. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00383-019-04449-6","article-title":"Readmission within 30 days of discharge (ReAd): A quality-of-care indicator in paediatric surgery","volume":"35","author":"Mears","year":"2019","journal-title":"Pediatr. Surg. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00383-020-04720-1","article-title":"The outcomes of conservative management and the natural history of asymptomatic hydroceles in children","volume":"36","author":"Kurobe","year":"2020","journal-title":"Pediatr. Surg. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s00595-016-1352-2","article-title":"Modified Marcy repair for indirect inguinal hernia in children: A 24-year single-center experience of 6826 pediatric patients","volume":"47","author":"Rikalo","year":"2017","journal-title":"Surg. Today"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.urology.2010.02.062","article-title":"Hydrocele of the spermatic cord in infants and children: Its particular characteristics","volume":"76","author":"Chang","year":"2010","journal-title":"Urology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1089\/lap.2019.0382","article-title":"Laryngeal mask airway versus tracheal intubation for laparoscopic hernia repair in children: Analysis of respiratory complications","volume":"30","author":"Vickov","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Technol. A"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/SLE.0000000000000878","article-title":"Percutaneous Internal Ring Suturing for the minimal invasive treatment of pediatric inguinal hernia: A 5-year single surgeon experience","volume":"31","year":"2021","journal-title":"Surg. Laparosc. Endosc. Percutan Technol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/j.jpedsurg.2015.07.007","article-title":"Ten year experience of laparoscopic repair of pediatric hydrocele and the long-term follow-up results","volume":"50","author":"Yang","year":"2015","journal-title":"J. Pediatr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s00464-010-1188-6","article-title":"Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients","volume":"25","author":"Montupet","year":"2011","journal-title":"Results Consid. A Debated Procedure. Surg. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"63","DOI":"10.7602\/jmis.2020.23.2.63","article-title":"Percutaneous Internal Ring Suturing for indirect inguinal hernia in pediatric patients","volume":"23","author":"Chang","year":"2020","journal-title":"J. Minim. Invasive Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1089\/lap.2019.0598","article-title":"A faster and simpler operation method for laparoscopic inguinal hernia repair in children","volume":"30","author":"Wang","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Technol. A"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Pogoreli\u0107, Z., Huski\u0107, D., \u010cohad\u017ei\u0107, T., Juki\u0107, M., and \u0160u\u0161njar, T. (2021). Learning curve for laparoscopic repair of pediatric inguinal hernia using percutaneous internal ring suturing. Children, 8.","DOI":"10.3390\/children8040294"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.jpedsurg.2015.11.024","article-title":"Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases","volume":"51","author":"Thomas","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5159","DOI":"10.1007\/s00464-017-5582-1","article-title":"A comparison between totally laparoscopic hydrocelectomy and scrotal incision hydrocelectomy with laparoscopic high ligation for pediatric cord hydrocele","volume":"31","author":"Choi","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1089\/lap.2014.0152","article-title":"Laparoscopic treatment of pediatric hydrocele and the evaluation of the internal inguinal ring","volume":"24","author":"Saka","year":"2014","journal-title":"J. Laparoendosc. Adv. Surg. Technol. A"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"17471","DOI":"10.1038\/s41598-023-44890-1","article-title":"The relevance of reducing Veress needle overshooting","volume":"13","author":"Postema","year":"2023","journal-title":"Sci. Rep."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/4\/437\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:23:57Z","timestamp":1760106237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/4\/437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["children11040437"],"URL":"https:\/\/doi.org\/10.3390\/children11040437","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,5]]}}}