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. |
