Laparoscopic-Assisted Percutanous Inguinal Hernia Closure in Children

Abstract

With advances in pediatric laparoscopic techniques and miniaturization of instruments, reports of successful laparoscopic inguinal hernia closure (LIHC) have increased in number. Percutaneous hernia closure under laparoscopic surveillance is one such technique which uses two trocars only. General anesthesia with laryngeal or face mask is used without muscle relaxation; a 5 mm port and scope are inserted through a subumbilical site by an open technique and a second (2 mm) trocar is inserted in the ipsilateral flank. A 2-0 absorbable suture on a 25 mm reverse cutting needle is introduced externally via the skin and abdominal wall just lateral to the visualized opening of the internal ring. This suture is manipulated by an external needle-holder so as to purse string (with the aid of an internal 2 mm grasper) the neck of the hernia. This needle is then passed into the abdominal wall taking full advantage of the needle's curvature, to be brought subcutaneously into its insertion point and tied. This closes the internal neck of the hernia, leaving it in continuity with the sac. Over a two-year period, 105 children underwent hernia closure using this technique. The procedure took an average of 10 minutes for unilateral and 15 minutes for bilateral cases. Three recurrences were detected over a 12-month followup period. There was a single case of umbilical port wound dehiscence. LIHC could provide the ideal operative approach for treating paediatric inguinal hernias if it had no proven disadvantages over the standard open procedure. As the reported recurrence rates following LIHC are currently unacceptably high, this technique cannot be considered an alternative to open surgery at present.