Direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM): a new modification for laparoscopic percutaneous inguinal hernia repair in children.

Abstract

Laparoscopic hernia repair has not gained widespread acceptance. Relatively high recurrence rate is a major cause. To reduce recurrence, we report a novel modification of laparoscopic percutaneous inguinal hernia repair in children by a retrospective cohort study. Between February 2020 and August 2021, children who underwent a laparoscopic percutaneous inguinal hernia repair with our modified technique were retrospectively evaluated. In our modification, we included the medial inguinal ligament in the Direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM): a new modification for laparoscopic percutaneous inguinal hernia repair in children. By doing so, the medial ligament is expected to act like a flep that reinforces the repair and prevent the peritoneal shearing and migration of the ligature. In total, 35 children were enrolled in the study with 23 boys and 12 girls. Right inguinal hernia (n = 23) was more common than left hernia (n = 10), while bilateral cases (n = 2) were less common. The median age of the patients was 38months and median operative time was 30min. An extraperitoneal hematoma was encountered in one patient that did not affect the postoperative course. No other intraoperative complication was encountered. No recurrence was observed during a median follow-up of 1month. Our modification of laparoscopic percutaneous hernia repair is a simple and reproducible technique that may have a place in the armamentarium of a pediatric surgeons. IV.