Laparoscopic-assisted percutaneous internal ring ligation in children

Abstract

Aim To evaluate the feasibility and safety of laparoscopic ligation of internal ring in congenital inguinal hernia in children.
Patients and methods Laparoscopic percutaneous ligation of internal inguinal ring has been performed on 97 children with 133 hernias. The age ranged between 6 months and 11.5 years. The procedure was carried out under general anesthesia, through skin puncture opposite to the lateral edge of the internal ring. The needle was passed under direct vision to encircle the internal ring without touching the vas or testicular vessels. The heel of the needle is backed through the subcutaneous tissue and out of the original stab puncture. The contralateral side was examined and the internal ring was closed if it was patent.
Results All children were subjected to a follow-up schedule for 1 year to evaluate both efficacy and reliability of the technique. The mean operative time in our series was 15 (± 3) and 20 (± 5) min for bilateral cases, without anesthesia time. Of 133 hernias repaired, two hernias recurred at 1 and 2 months postoperatively. Conversion rate was 0% in our hands. Five (3.8%) cases developed minimal extraperitoneal hemorrhage during surgery. Six (4.5%) cases developed mild hydrocele, which was successfully treated conservatively.
Conclusion Laparoscopic percutaneous ligation of internal inguinal ring repair of congenital hernia is proved to be a safe, simple, and easy procedure and can be performed routinely. The procedure has better cosmetic effect because we use a single umbilical port only. The high safety of the procedure we devised is because the cord contents remained untouched during the procedure.

Keywords: extracorporeal, inguinal hernia, laparoscopy, subcutaneous ligation