Transumbilical Two-Port Laparoscopic Percutaneous Extraperitoneal Closure: A New Technique for Inguinal Hernia Repair in Children

Abstract

Since laparoscopic hernia repair was reported a few decades ago, many techniques have been developed. A simplified and safe procedure with a low recurrence rate and good cosmetic result is the main concern. In this study, we introduced a new method, transumbilical two-port laparoscopic percutaneous extraperitoneal closure (TTPLPEC), and evaluated the safety and feasibility of this method. Five hundred thirty-six patients who accepted the TTPLPEC procedure in our hospital from July 2008 to January 2012 were analyzed retrospectively. During the TTPLPEC procedure, a laparoscope was placed through a supraumbilical incision. A 3-mm grasping forceps was inserted into the peritoneal cavity through a 3-mm infraumbilical incision. Using a hooked needle, the hernia sac was closed extraperitoneally. In total, 731 inguinal repairs were performed in 536 children with an age range from 3 months to 14 years. All operations were completed successfully by TTPLPEC. Contralateral patent processus vaginalis was found in 43.0%. For female patients, the mean operation time was 8.3 minutes for the unilateral procedure and 12.8 minutes for the bilateral procedure; for male patients, the mean operation time was 12.5 minutes and 18.6 minutes, respectively. At follow-up, there were two recurrences (0.37%) and 2 missed cases of contralateral patent processus vaginalis that developed a metachronous hernia. No other postoperative complication was noted. Six months after the operation, most patients had no obvious signs of a previous operation. The preliminary results showed satisfactory outcomes with TTPLPEC in the treatment of inguinal hernia in children. This technique for inguinal hernia repair in children appears to be safe and feasible, has good cosmetics, and has a low recurrence rate.