Laparoscopic repair of congenital inguinal hernia: a comparative study between purse–string suture and peritoneal disconnection with ligation techniques in bilateral cases

Abstract

Background/purpose Many laparoscopic surgical techniques were described for management of inguinal hernia in pediatric patients. This prospective study was conducted to compare laparoscopic purse-string suture of hernia sac at the internal ring at one side, leaving the distal sac intact (technique I) and disconnection of the hernia sac with intra-corporeal suture of proximal part at the internal ring (technique II) in the other side in the same case. Patients and methods Thirty three patients with bilateral congenital inguinal hernia (66 repairs) were included in this study. The outcome variables were operative time, intraoperative complications, post-operative complications and recurrence rate. Results This study included 28 males and 5 females. The age of the patients ranged from 1 to 72 month with a mean of (15.27 ± 19.09). The operative time was shorter in technique I than in technique II and this difference was statistically significant. No intraoperative complications were reported. Five cases (15%) developed hydrocele and two cases (6%) developed recurrence in technique I during the follow up period. Conclusion Laparoscopic repair of congenital inguinal hernia using laparoscopic disconnection of the sac and closure of the internal ring has lower recurrence rate and hydrocele formation but longer operative time compared to laparoscopic purse-string closure alone. Due to the high rate of recurrence in technique I, there is definite superiority of technique II as a surgical option.

Needlescopic Disconnection and Peritoneal Closure for Pediatric Inguinal Hernia Repair: A Novel Technique

“…They concluded that there was a definite superiority with division of the hernia sac and peritoneal closure. 3 We succeeded to report no recurrence in any case after a mean of 19.6 ± 3.2 months' follow-up in well selected cases. The novel technique reproduces every step of the conventional open procedure; dissection, division, and suture closure of the hernia defect at the IIR with very secure knot.…”

“…Almotaher and colleagues reported on 33 patients with bilateral CIH applying only laparoscopic purse-string suturing to one side and laparoscopic division and closure at IIR to the other side. They concluded that there was a definite superiority with division of the hernia sac and peritoneal closure 3…”

“…Laparoscopy has many advantages including excellent visualization with a lower possibility of gonadal vessels and vas injury, minimal tissue trauma, shorter hospitalization, faster recovery, better cosmesis, and comparable recurrence rates as described in many literatures 3,5,6…”

“…[2][3][4][5] Laparoscopy has many advantages including excellent visualization with a lower possibility of gonadal vessels and vas injury, minimal tissue trauma, shorter hospitalization, faster recovery, better cosmesis, and comparable recurrence rates as described in many literatures. 3,5,6 There is an ongoing debate regarding the best laparoscopic technique to repair CIH. However, laparoscopic disconnection of hernial sac and suture closure of the peritoneal defect (PD) at internal inguinal ring (IIR) mimics open herniotomy and several studies addressed its superiority over other techniques with 0.3% to 1.2% recurrence.…”

“…In the last decade, laparoscopy gained wider acceptance and more usage in CIH repair even if, there is insufficient evidence to support its benefits over open approach. [2][3][4][5] Laparoscopy has many advantages including excellent visualization with a lower possibility of gonadal vessels and vas injury, minimal tissue trauma, shorter hospitalization, faster recovery, better cosmesis, and comparable recurrence rates as described in many literatures. 3,5,6 There is an ongoing debate regarding the best laparoscopic technique to repair CIH.…”