Abstract
The techniques of minimal access surgery for pediatric inguinal hernia are numerous and they continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port endoscopic-assisted percutaneous extraperitoneal closure seems to be the ultimate attainment, and numerous techniques have mushroomed in the past decade. This article comprehensively reviews and compares the various single-port techniques. These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect. However, most of these emerging techniques fail to entirely enclose the hernia defect and have the potential to lead to higher incidence of hernia recurrence. Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.
Highlights
Traditional inguinal herniotomy is a well-developed surgical technique for uncomplicated inguinal hernia in infants and children
The hernia defect could be enclosed completely without a lower peritoneal gap since preperitoneal hydrodissection could safely separate the peritoneum from the vas and the vessels
Since the tensile strength of any suture may diminish eventually, the author suggests that peritoneal adhesion and fibrosis may be the leading factor for complete obliteration of the hernia defect in the long run after either open herniotomy or laparoscopic surgery (Figure 4)
Summary
Traditional inguinal herniotomy is a well-developed surgical technique for uncomplicated inguinal hernia in infants and children. It usually necessitates one small 1.5 to 2 cm skin incision, and the possible postoperative complications, such as recurrence or injury to the vas deferens, are not high [1]. Partial omission of the defect circumference, strength and appropriateness of the knot, inclusion of tissue other than peritoneum in the suture with a propensity for subsequent loosening, use of absorbable sutures, and failure to detect a rare or direct hernia are some reported factors contributing to recurrence in laparoscopic surgery [2]. To enhance a pediatric surgeon’s willingness, further development is intended to decrease the number and size of skin incisions, lower the recurrence rate, and simplify or avoid intracorporeal technique [2]. The author reviews the literature in an attempt to compare the various approaches of the latest advancement in pediatric hernia surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
