Laparoscopic percutaneous internal ring suturing for paediatric inguinal hernias: a South African tertiary centre experience

Abstract

Background: Laparoscopic inguinal hernia repair is routine in many paediatric centres. One of several techniques described in 2006 is the laparoscopic percutaneous internal ring suturing (PIRS) technique. This technique which is not widely used in South Africa has been adopted for paediatric inguinal hernias at our institution, and this is a review of the experience.
Method: The study is a retrospective review of the patients who underwent PIRS (a single port combined percutaneous procedure used to close the internal ring) at our hospital from October 2018 until March 2020. We describe the technique in our setting and review our cohort of patients, demographics, clinical presentation, operative duration and complications.
Results: One hundred and ten laparoscopic PIRS procedures were performed on 94 patients; 15 had bilateral inguinal hernias. Polydioxanone and Prolene were the sutures used for the procedures. Average operative time was 12 minutes for unilateral hernias and 33 minutes for bilateral hernias. All operations were completed laparoscopically. Follow-up was for a minimum of three months, but up to 21 months. Complications included three intraoperative haematomas, three hydrocoeles and two umbilical granulomas postoperatively. There were two recurrent hernias of which one was managed with redo PIRS; the other required open herniotomy for an irreducible obstructed hernia.
Conclusion: This review is supportive evidence that the PIRS technique for managing paediatric inguinal hernias in a tertiary institution in South Africa can be performed safely with few complications.