Needlescopic suturless repair of congenital inguinal hernia: A randomized controlled study

Abstract

Background: Many techniques have been published in the literature about laparoscopic treatment of congenital inguinal hernia [CIH]. Division of the sac, with suturing the peritoneal defect has been advocated by many authors. Others stated that peritoneal disconnection alone is enough. This study aimed to compare the results of needlescopic disconnection of CIH sac with or without peritoneal defect suturing as regards feasibility, operative details, recurrence rate, and postoperative complications. Patients and Methods: This study has been conducted prospectively on children operated upon by needlescopic separation of hernia sac at its neck with or without peritoneal defect suturing over the Internal Inguinal Ring [IIR] in the period from January 2020 to December 2022. Results: A total of 230 patients with 260 hernial defects were corrected by needlescopic disconnection with either suturing or without suturing of the defect. They comprised of 141 (61.3%) males, and 89 (38.7%) females. Their ages ranged from 0.5 to 12 years (mean=5.14 ± 2.79). Patients were distributed into group A (N=116 patients) and group B (N=114 patients). In sac separation and closure of the defect group A, the mean operative time was 27.98 ± 2.89 [Rang = from 20 to 30 minutes] for unilateral cases and 37.29 ± 4.68 [Range = from 25 to 40 minutes] for bilateral one, whereas in group B, the mean operative time was 20.37 ± 2.37 [Range=from 15 to 25 minutes] for one-sided and 23.38 ± 2.22 [Range =from 20 to 25 minutes] in two-sided cases. Conclusion: Needlescopic separation of hernia sac with suturing of peritoneal defect and disconnection without suturing for pediatric inguinal hernia repair, are feasible, safe, and less invasive with no recurrence and outstanding cosmetic results. However, non- suturing of peritoneal defect gives significantly shorter operative time than suturing of peritoneal defect

Pediatric incarcerated inguinal hernia: Traditional open or laparoscopic-assisted approach?

“…If not treated in time, serious complications, such as intestinal obstruction, intestinal strangulation, necrosis, or even testicular or ovarian necrosis, may occur. [13,14] The traditional treatment of an incarcerated indirect inguinal hernia involves making an inguinal incision, locating the inguinal sac, releasing the internal ring orifice, removing the hernia contents, separating the hernia sac, and performing high ligation of the hernia sac. However, when an incarcerated inguinal hernia occurs, the tissue layers cannot be clearly distinguished because of the severe local edema caused by the incarcerated contents of the hernia.…”