Laparoscopic Extracorporeal Ligation of Hernia Defects Using an Epidural Needle and Preperitoneal Hydrodissection

Abstract

Purpose: This article presents the extracorporeal ligation of inguinal hernia defects using an epidural needle and preperitoneal hydrodissection. Patients and Methods: Thirteen children underwent laparoscopic extracorporeal ligation of their hernia defect using an epidural needle and preperitoneal hydrodissection. A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision, a Veress needle for forceps was inserted halfway between the umbilicus and the anterior superior iliac spine on the contralateral side of the hernia, and a 17-gauge epidural needle was inserted at the point of the internal inguinal ring. The hernia defect was closed extracorporeally by a nonabsorbable suture, which was introduced into the abdomen through the epidural needle on the lower half of the hernia defect and withdrawn on the opposite side by a wire-loop through the epidural needle going along the upper half side of the hernia defect in a series of movements. When a contralateral hernia defect is present, laparoscopic-assisted extracorporeal ligation of the contralateral hernia defect is performed during the same operation. Results: All patients were discharged uneventfully from the hospital within 24 hours postoperatively. The mean follow-up period is 6.1 months (range 2-12 mos), and no recurrence has been observed to date. Conclusions: This article describes a unique technique of extracorporeal circuit suturing of inguinal hernia defects using a minimally invasive technique as afforded by an epidural needle.

Laparoscopic needle-assisted inguinal hernia repair in 495 children

“…Our laparoscopic, needle-assisted repair (LNAR) technique is similar to the percutaneous internal ring suturing technique, which has been previously described [17], and similarly, described by Tatekawa in 2010 [18], although we were using this technique almost 2 years prior. An important modification from Patkowski [17] is the use of a long and maneuverable, small bore, Tuohy spinal needle rather than an 18-gage injection needle.…”

Laparoscopic Extracorporeal Ligation of the Internal Inguinal Ring by a Spinal Needle: a Simple Method of Hernia Repair in Children

“…But during laparoscopy, it becomes obvious automatically. Some authors suggest that PPVs less than 2 mm may be left alone [6], but other had routinely ligated it to avoid development of metachronous hernia [15]. In our series, contralateral hernias were detected in two cases by laparoscopy and were repaired at the same time.…”

“…Lifting the peritoneum with the help of 3-mm Maryland forceps ensures a complete encirclement of the internal ring without skip area. Literature search revealed that a similar method was described by Tatekawa [15] in 2012 by the use of an epidural needle and preperitoneal hydrodissection to separate the vas and vessels. But we believe that vas and vessels can be well preserved by lifting the peritoneum by the 3-mm Maryland forceps.…”

“…While in laparoscopic hernia repair, it ranged from 0.7 to 4.5 % [16]. On the contrary, Shalaby et al had reported a lower recurrence rate (0.8 %) after laparoscopic repair by RN and 2.4 % recurrence after open herniotomy [15]. Avoiding the gonadal vessels and vas deferens during subcutaneous endoscopic ligation may leave a small gap in the IIR [9,17,18].…”

Single-port laparoscopic percutaneous double ligation for pediatric inguinal hernias: report of a new technique and early results

“…The hydrodissection technique was used in all cases in the current study, which could help surgeons separate the vas deferens and testicular vessels from the peritoneum [7,11,12]. This made a complete circuit of suturing around the neck of the hernial sac, and this was essential to reduce recurrence of hernias.…”