Background: Laparoscopic herniorrhaphy in pediatric surgery is usually performed through three ports
in the abdominal wall with intraperitoneal suturing. Our technique of percutaneous internal ring suturing
(PIRS) requires only one umbilical port and needle puncture point. We describe the technique
and evaluate the efficacy of percutaneous internal ring suturing for inguinal hernia repair in children.
Materials and Methods: We performed percutaneous internal ring suturing on 106 children (ages
28 days–14.5 years) with 140 hernias. The procedures were performed under general endotracheal
anesthesia. Pneumoperitoneum was established with an open technique. Under laparoscopic-guided
vision an 18-gauge injection needle with a nonabsorbable thread inside the barrel of the needle was
placed through the abdominal wall into the peritoneal cavity. By moving the injection needle, the
thread passed under the peritoneum around the entrance into the hernia sac. The knot was tightened
from outside and placed in the subcutaneous space. The contralateral open inguinal ring was
closed in the same procedure.
Results: The average operative time was 19 minutes for unilateral and 24 minutes for bilateral
hernias. Follow-up ranged between 18 and 29 months. Cosmetic results are excellent with almost
invisible scars. There were 3 cases of intraoperative complication: incidental puncture of the iliac
vein that required no treatment. There were 4 cases of postoperative complications: one case of ileus
adhesion with bowel strangulation, and hernia recurrence in 3 boys, one of whom was reoperated
with percutaneous internal ring suturing. In 5 boys, transient hydroceles were observed that disappeared
spontaneously after 3 to 5 months.
Conclusion: The percutaneous internal ring suturing method seems to be a simple and effective
minimally invasive procedure with excellent cosmetic results. The rate of complications is comparable
to other laparoscopic techniques of inguinal hernia repair in children. According to our experience,
percutaneous internal ring suturing should be considered as a treatment alternative.
