Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients

Abstract

Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias.

A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China

“…High ligation of the hernia sac can achieve satisfactory results [ 2 ]. Traditional open hernia repair (OHR) has been implemented in the clinic for many years, which has the characteristics of simple operation and strong popularity [ 3 ]. Some scholars believe that it is necessary to open the inguinal canal, which causes postoperative pain, and it is easy to damage spermatic vessels and the vas deferens [ 4 ].…”

Pediatric inguinal hernia treated by single-port laparoscopic water injection hernia crochet needle.

“…The hernial sac wall in children is quite thin, and the testicular ducts are fine; thus, excessive disassociation and dissection are likely to result in hernial sac wall avulsion as well as damage to testicular ducts and spermatic vessels. Moreover, it is linked with a high postoperative recurrence rate, as well as a risk of complications such as scrotal hematoma, testicular atrophy, and iatrogenic cryptorchidism [2,5,6].…”

“…With regard to treatment of pediatric inguinal hernia, traditional open surgery mostly makes an abdominal transverse cleavage line incision through the groin, which requires cutting open multiple layers of abdominal wall tissues, separating the spermatic vessels and testicular ducts after finding the hernial sac, and isolating and high ligation of the hernial sac, thereby causing great surgical trauma. In the past 20 years, with the development of minimally invasive technology, laparoscopic inguinal herniorrhaphy has been emerging in China and in other countries [1,2]. Numerous clinical studies indicate that laparoscopic surgery is obviously superior to traditional surgery for pediatric inguinal hernia, especially for children with bilateral hernias, giant hernia, and recurrent hernia, which shows a trend towards replacing the traditional open surgery [3,4].…”

Umbilical Quilting Suture Technique during Single-Port Laparoscopic Surgery

“… 4 , 5 Because scars can have psychological consequences, postoperative scar cosmesis is a critical concern of women, especially young women. 6 – 8 …”

“…To overcome postoperative distortion, quilting sutures on the incision site are needed during wound closure. 8 , 18 , 19 Anchoring the skin flap on the underlying fascia provides a depressed vertical line on the center of the umbilicus, whereas the conventional wound closure procedure without quilting sutures does not guarantee a straight vertical line and the presence of a definite depression within the umbilicus. As the center line is fixed straight on the underlying fascia, the tissues around the incision line do not bulge.…”