Background: There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose:The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children.Patients and Methods: Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy.Results: A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58 ± 1.26 (range = 2 to 8 y) and mean internal inguinal ring diameter was 13.65 ± 3.85 mm (range = 8 to 20 mm). The mean operative time was 23.36 ± 4.67 minutes for bilateral and 14.28 ± 2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6 ± 3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively.Conclusions: Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with pursestring suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

Level III, comparative study.

No abstract

Background: The desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine. Methods: The first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate. Results: The sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ± 1.2 months. Conclusion: The closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.

Thirty patients with secondary infertility were subjected to laparoscopic adhesiolysis during the period January 1986 to February 1987 at Al-Azhar Endoscopy and Microsurgery Unit. Second look laparoscopy (SLL) was performed after a period of 9-12 months. At laparoscopy, pelvic adhesive disease was staged according to the severity of the disease and compared with the finding at SLL. Five patients defaulted, three patients (12%) became pregnant and 22 patients underwent SLL. Ten patients (45.5%) showed no recurrence of adhesions. This study suggests that laparoscopy has a role in adhesiolysis of mild and moderate adhesions and SLL provides further opportunity to relyse reformed adhesions in some cases.