Pediatric inguinal hernia repair with a single-incision approach using an Endo Close™ suturing device.

Abstract

Diverse techniques have been described for pediatric inguinal hernia repair, based on extraperitoneal [1-4] and intraperitoneal [5-8] methodologies. In this video, we describe a novel technique to repair pediatric inguinal hernia using an Endo Close™ suturing device by percutaneous puncture with a single incision. With a transumbilical approach, a 5-mm trocar is inserted for a 30° laparoscope. A 3-mm incision is made, and the Endo Close™ suturing device (Covidien, Minneapolis, MN, USA), with a 2-0 polypropylene suture retained by the stylet, is inserted perpendicularly to the skin. An extraperitoneal dissection is made on a side the inguinal ring and the needle of the device penetrates the peritoneum through the inferior border. Then, the stylet mechanism is pushed to free the lasso inside the cavity. At the same incision site, the needle of the Endo Close™ is inserted again, but an extraperitoneal dissection is made on the other side of the ring, ensuring that the needle penetrates at the same exit orifice. Now, the suture lasso is recovered and retracted to close the ring. Finally, the suture is extracted and knots are tied extracorporeally at the level of the skin. A total of 34 patients (20 females and 14 males) underwent surgery with this procedure. Operative time for unilateral repair was 10-15 and 25-30min for the bilateral repair (29 unilateral/5 bilateral). The patients experienced minimal postoperative pain. The follow-up period was 12months with no complications, no recurrence and without cases of postoperative hydrocele. There were no injuries to the structures as vessels or vas deferens, and the esthetic outcome was excellent. The technique presents a simple, safe and reliable method to repair inguinal hernias in children. The long-term results of this novel technique will be evaluated in future studies.