Laparoscopically Assisted Single-trocar Extracorporeal Piecemeal Internal Ring Closure for Indirect Inguinal Hernias in Children.
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Objectives: This study aimed to evaluate the short-term outcome of extracorporeal singleport piece-meal closure of the internal inguinal ring in children older than 6 months. Patients & Methods: The study included 40 patients; 26 males and 14 females with mean age of 3.41.8 years. Eight patients (20%) had bilateral and 32 patients had unilateral hernias. Exploratory lapatoscopy of tile contralateral inguinal region was conducted for cases had unilateral hernia. Under laparoscopic guided vision using 5mm, 30 telescope, a prolene or vicryi 2/0 or 3/0 suture on a curved rounded tapered-ended needle was introduced through an inguinal skin crease incision using a needle holder, passed through the abdominal wall layers till the peritoneum and had manipulated to pick up the peritoneum in piecemeal all around the internal ring and then the needle was pushed to the outside near to the entrance site thus forming half a circle around the internal ring. Finally the needle has passed back subcutaneously towards the entrance site and the suture tied subcutaneously. The frequency of intraoperative diagnosis of bilateral hernias, total theater time, duration of hospital stay, the frequency and severity of complications, duration of follow-up and recurrence rate were determined. Results: Exploratory laparoscopy detected 9 occult inguinal hernias in patients with unilateral hernia for a frequency of 28.1% for intraoperative detection of synchronous contralateral hernia. Mean operative time was 254; 18-30 minutes for unilateral cases and was 34.63.8; 30-45 minutes for bilateral cases. No conversion to open surgery was needed. Mean postoperative hospital stay was 4.31.S hours and 70% of patients allowed going home within the range of 3 to 6 hours. Only one patient had bilateral hernia developed recurrence 4- months after surgery and was managed using open approach. Conclusion: The applied procedure using single trocar for piecemeal closure of internal inguinal ring in children is safe, effective day-case procedure with satisfactory cosmetic appearance and contralateral hernia detection rate of 28.1% without prolongation of operative time and recurrence rate of 1.7% per hernia.