No-trocar laparoscopic approach for high ligating inguinal hernias in children using mini-instruments

Abstract

Objective To evaluate the feasibility and safety of a novel laparoscopic approach for high ligating inguinal hernias in children using two microincisions besides umbilical and intraperitoneal knot-tying.Methods Between June 2012 and October 2013,a total of 136 inguinal high ligations were performed for 102 children.There were 86 boys and 16 girls with a mean age of 2.4 years (25 days-13.6 years).Their clinical data were retrospectively analyzed.One 5 mm trocar was inserted through umbilicus into abdomen.Forceps and needle holder were punctured into abdomen through two 3 mm incisions at both sides of umbilicus without trocars.2-0 non-absorbable suture was introduced into the peritoneal cavity through anterior abdominal wall near internal inguinal ring.The orifice of hernial sac was closed extraperitoneally with a purse-string suture around internal inguinal ring and intraperitoneal knot-tying performed.Results All operations were completed successfully.The mean operative duration was 15.5 min for unilateral and 20.2 min for bilateral lesions.No postoperative bleeding,abdominal wall emphysema,abdominal viscera injury or scrotal edema was found.And there was no occurrence of postoperative testicular atrophy/hypotrophy or hernia recurrence.And 93％ of them resumed routine activities at Day 1 postoperation.During a mean follow-up period of 9.9 (4-17) months,there was no report of recurrence,visible scar on abdominal wall or foreign body feel of inguinal portion.Conclusions Mini-invasive laparoscopic approach is both safe and efficacious for inguinal hernia in children.The difficulty is the same as tri-port laparoscopic technology.And its cosmetic outcome is similar as the single-port laparoscopy. Key words: Hernia, inguinal; Laparoscopy; Surgical instruments