Modified Laparoscopic Percutaneous Extraperitoneal Closure of Indirect Inguinal Hernia in Children

Abstract

Background: Laparoscopic assisted percutaneous extraperitoneal closure (LPEC) of the hernia is a recently well-developed technique for inguinal hernia repair in children. Because twice of the needle insertion passes through a different tunnel remains a concern, this not only leads to simultaneous ligation of subcutaneous tissues between the skin and hernia sac but also leaves the knot palpable in the subcutaneous space. This study offers a modified LPEC technique to overcome these limitations. Patients and Methods: A total of 72 children with 106 hernias accepted the procedure from January 2014 to June 2014. A homemade hernia needle with 2-0 nonabsorbable suture material was inserted over the deep ring to the patent processus vaginalis (PPV). The orifice of the hernia sac was closed extraperitoneally with circuit ligating of the internal inguinal ring. The modification of our method is that during the whole procedure, the needle always closely clung to the peritoneum, no “pull-out” when starting in the opposite direction, this ensures a single channel for twice needle insertion, so that no subcutaneous tissues would be ligated incidentally thus shortening the operation time. In addition, the knot was tied tightly from outside and buried deeply near the peritoneum, far away from the subcutaneous tissue, so that the suture reactions are completely prevented. The contralateral PPV was closed simultaneously. Results: The median operative time for unilateral/bilateral hernias in boys and girls was, respectively, 11.7/19.9 minutes and 8.3/15.6 minutes. Twenty-six (40.6%) children were found to have a contralateral PPV during laparoscopy. Two boys (2.8%) appeared to have a coexistence of indirect hernia and a direct hernia on the left side. There were no suture reaction or other serious complications associated with the procedure in this study. No hernia recurrence, testicular atrophy, or ascent was found in the follow-up time. Cosmetic results are excellent. Conclusion: The modified LPEC technique is an effective and feasible minimally invasive procedure for inguinal hernia repair, which can overcome the deficiency and retain the advantage of the existing methods; this technique should be considered as a superb alternative treatment in children. Yan Xue-qiang and Kuang Hou-fang have contributed equally to this work. No competing financial interests exist. Runtime of video: 5 mins