Single-port laparoscopic internal ring closure with medial umbilical fold flap reinforcement using a two-hooked core hernia needle

Abstract

Objective To describe single-port laparoscopic internal ring closure combined with the ipsilateral medial umbilical fold flap (MUFF) cover using a two-hooked core needle. Methods Fifty-nine children with huge inguinal hernias were encountered MUFF reinforcement after laparoscopic percutaneous extraperitoneal closure (LPEC). Under single-port laparoscopic vision, an inner two-hooked needle with a non-absorbable suture was inserted at abdominal transverse striation closed to hernia ring and was readily kept in an identical subcutaneous path. The hernia ring was ligated using the hydrodissection technique. Afterwards, the needle with another non-absorbable suture was inserted at identical subcutaneous path and the suture was left after penetrating the ipsilateral medial umbilical fold, then the needle was re-introduced into abdomen through lateral extraperitoneal space and the suture at bottom of medial umbilical fold was grabbed and extracorporeal ligated. The closed orifice area was additionally reinforced due to MUFF cover. Results In Fifty-nine children, A total of 65 huge inguinal hernias (including three previous recurrences and one complex hernia) were successfully completed LPEC with additional MUFF reinforcement. In which, 16 cases were found contralateral patent processus vaginalis needed to have LPEC. Mean operating time for unilateral and bilateral repairs were (11.2 ± 2.2)min and (15.8 ± 2.7)min respectively. There were no recurrence, iatrogenic cryptorchidism or testicular atrophy postoperative except for one hydrocele formation and two suture granulomas. Conclusions Single-port LPEC with MUFF reinforcement using a two-hooked core needle is safe and feasible, as a handy technique with invisible scar has proved to be a safe and effective approach and is therefore a worthy option in treatment of pediatric huge inguinal hernia. Key words: Huge inguinal hernia; Single-port laparoscopy; Two-hooked core needle; Internal ring closure; Medial umbilical fold