Comparative study between purse–string suture and peritoneal disconnection with ligation techniques in the laparoscopic repair of inguinal hernia in infants and children

Abstract

Background Laparoscopic hernia repair in children is becoming more popular nowadays. A lot of laparoscopic techniques were described to repair inguinal hernia in infants and children; however, there are few reports on laparoscopic disconnection of the hernia sac at internal inguinal ring (IIR) as a method for hernia repair.
Purpose The objective of this study was to compare intracorporeal purse–string suturing leaving the hernia sac in continuity and laparoscopic disconnection of the hernia sac at IIR and proximal closure of the peritoneum for repair of inguinal hernia in infants and children. A randomized prospective study was carried out in the Pediatric Surgery Unit of Alexandria University Hospitals (Alexandria, Egypt) on 40 male children.
Patients and methods Forty male patients (48 repairs) were randomized into two equal groups (n= 20). Group A was subjected to intracorporeal purse–string suturing around the IIR leaving the hernia sac in continuity. Group B was subjected to disconnection of the hernia sac from the parietal peritoneum at the level of IIR, followed by proximal closure of the peritoneum. Inclusion criteria were as follows: male inguinal hernia, either unilateral or bilateral, and age between 6 months and 12 years. Exclusion criteria were as follows: female inguinal hernia, hernia with undescended testicles, recurrent inguinal hernia, and previous major lower abdominal surgery. The main outcome measurement was recurrence, and secondary outcome measurements were operative time, hospital stay, intraoperative complications, postoperative hematoma, postoperative testicular atrophy, and postoperative hydrocele formation.
Results There were no significant differences between the two groups as regards age, sex, and mode of presentation. All cases were completed laparoscopically without conversion. Group A showed a significantly higher rate of recurrence as well as hydrocele formation compared with group B; however, there was no difference as regards the operative time, hospital stay, and testicular atrophy.
Conclusion Laparoscopic hernia repair using the peritoneal closure following disconnection of the hernia sac is a safe and feasible method for hernial repair with minimal complications. It has a lower recurrence rate compared with the purse–string suturing alone, with no added risk for injury to the vas and vessels.