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

Abstract

Laparoscopic repair has emerged recently as an alternative technique for hernia repair in children. Various methods of repair have been described. Basic principle is to close the internal inguinal ring either by intracorporeal or by extracorporeal suturing. The objective of this study is to describe and evaluate the outcome of a simple technique of internal ring closure by a spinal needle. A total of 43 hernias in 41 patients were repaired. A prolene thread was passed percutaneously around the internal inguinal ring by threading it though a spinal needle under laparoscopic control. The suture is then tied extracorporeally in the subcutaneous plane. There were 15 female and 26 male patients in the age group of 1½ to 12 years. Right-sided hernia was present in 31 cases and left-sided hernia in eight cases, and two cases had bilateral hernia. All cases were repaired successfully. There was no intraoperative or postoperative complication. This new technique has all the advantages of laparoscopic hernia repair in children (minimally invasive, less pain, less complication, and cosmesis). In addition, the method is simple and it does not need any special equipment or advanced laparoscopic skill.

Laparoscopic needle assisted extracorporeal repair of inguinal hernia in children: our experience

“…1,2,5,9,11 Literatures shows mean operative time for laparoscopic needle assisted extracorporeal unilateral repair was 10.5-20.5 minutes and in bilateral it was 20-26.4 minutes. 1,2,9,11,12 In our study, the mean operative times were a bit longer; it was due to long learning period. Manoz Shaha felt the same problem in his series.…”

“…Manoz Shaha felt the same problem in his series. 12 In our series, complications like mild bleeding from needle puncture site, transient hydroceles and recurrence noted in few cases. Use of Trend Ellensburg's position and needle puncture under direct camera vision can avoid mostly feared gut and vessel injury.…”

“…12 The recurrence rate is higher for the laparoscopic treatment of inguinal hernia than the traditional open approach, although the difference is not significant [1]. Complete encirclement of the ring, emptying the sac, and reducing the abdominal pressure before tying may help in reducing hydroceles formation and recurrence of hernia [12]. On follow up, we found four case of recurrences hernia within 4 months which were repaired by open technique after 6 months.…”

“…Due to limited experience we did not perform laparoscopic hernia repair below 1 year of age, recurrent hernia, hernia in obese patients, obstructed and incarcerated hernia and patients with congenital heart disease The advantage of laparoscopic inguinal hernia repair in children is that the direct approach to the internal inguinal ring avoids opening the inguinal canal, easy evaluation of the contra lateral side, minimum dissection and avoidance of injury to vas and vessels and iatrogenic ascent of the testis, and decreased operating time and reduced incidence of testicular atrophy. 1,4,8,[10][11][12][13] In this study, we have close the defect in the internal inguinal ring using 5-mm umbilical port for laparoscopic visualization, a Maryland forceps introduced directly through a small stub wound lateral to the rectus muscle and an 18G or 20G needle (depending on the ages) treated with 3/0 polypropylene within it inserted at the midpoint of the inguinal line for extra-corporeal knot tying.…”

“…[13][14][15] Open herniotomy in children has been reported to have recurrence rates of 0.8-3.8%, while in laparoscopic hernia repair, it ranged from 0.7 to 4.5%. 12 The recurrence rate is higher for the laparoscopic treatment of inguinal hernia than the traditional open approach, although the difference is not significant [1]. Complete encirclement of the ring, emptying the sac, and reducing the abdominal pressure before tying may help in reducing hydroceles formation and recurrence of hernia [12].…”