Laparoscopic Extracorporeal Ligation of Hernia Defects Using an Epidural Needle and Preperitoneal Hydrodissection

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This article presents the extracorporeal ligation of inguinal hernia defects using an epidural needle and preperitoneal hydrodissection. Thirteen children underwent laparoscopic extracorporeal ligation of their hernia defect using an epidural needle and preperitoneal hydrodissection. A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision, a Veress needle for forceps was inserted halfway between the umbilicus and the anterior superior iliac spine on the contralateral side of the hernia, and a 17-gauge epidural needle was inserted at the point of the internal inguinal ring. The hernia defect was closed extracorporeally by a nonabsorbable suture, which was introduced into the abdomen through the epidural needle on the lower half of the hernia defect and withdrawn on the opposite side by a wire-loop through the epidural needle going along the upper half side of the hernia defect in a series of movements. When a contralateral hernia defect is present, laparoscopic-assisted extracorporeal ligation of the contralateral hernia defect is performed during the same operation. All patients were discharged uneventfully from the hospital within 24 hours postoperatively. The mean follow-up period is 6.1 months (range 2-12 mos), and no recurrence has been observed to date. This article describes a unique technique of extracorporeal circuit suturing of inguinal hernia defects using a minimally invasive technique as afforded by an epidural needle.