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Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children
Dariusz Patkowski1, Jerzy Czernik, Rafał Chrzan
1Department of Pediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland. dpat@chdz.am.wroc.pl
Insights
Percutaneous internal ring suturing (PIRS) offers a minimally invasive approach for pediatric inguinal hernia repair using a single umbilical port. This technique demonstrates effective outcomes with excellent cosmetic results and a comparable complication rate to other laparoscopic methods.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Traditional laparoscopic pediatric inguinal hernia repair involves multiple ports and intraperitoneal suturing.
- Percutaneous internal ring suturing (PIRS) utilizes a single umbilical port and needle puncture for reduced invasiveness.
Purpose of the Study:
- To describe the technique of percutaneous internal ring suturing (PIRS).
- To evaluate the efficacy and safety of PIRS for inguinal hernia repair in children.
Main Methods:
- PIRS was performed on 106 children (28 days–14.5 years) for 140 hernias under general anesthesia.
- A laparoscopic-guided technique used an 18-gauge needle with nonabsorbable thread to suture the internal ring through the abdominal wall.
- Contralateral inguinal rings were closed concurrently when necessary.
Main Results:
- Average operative time was 19 minutes (unilateral) and 24 minutes (bilateral).
- Follow-up ranged from 18 to 29 months.
- Excellent cosmetic results with minimal scarring; 3 intraoperative (iliac vein puncture) and 4 postoperative complications (ileus, 3 recurrences, 5 transient hydroceles) were noted.
Conclusions:
- PIRS is a simple, effective, and minimally invasive technique for pediatric inguinal hernia repair.
- The procedure yields excellent cosmetic outcomes.
- Complication rates are comparable to other laparoscopic techniques, positioning PIRS as a viable treatment alternative.
Background:
Laparoscopic herniorrhaphy in pediatric surgery is usually performed through three ports in the abdominal wall with intraperitoneal suturing. Our technique of percutaneous internal ring suturing (PIRS) requires only one umbilical port and needle puncture point. We describe the technique and evaluate the efficacy of percutaneous internal ring suturing for inguinal hernia repair in children.
Materials And Methods:
We performed percutaneous internal ring suturing on 106 children (ages 28 days-14.5 years) with 140 hernias. The procedures were performed under general endotracheal anesthesia. Pneumoperitoneum was established with an open technique. Under laparoscopic-guided vision an 18-gauge injection needle with a nonabsorbable thread inside the barrel of the needle was placed through the abdominal wall into the peritoneal cavity. By moving the injection needle, the thread passed under the peritoneum around the entrance into the hernia sac. The knot was tightened from outside and placed in the subcutaneous space. The contralateral open inguinal ring was closed in the same procedure.
Results:
The average operative time was 19 minutes for unilateral and 24 minutes for bilateral hernias. Follow-up ranged between 18 and 29 months. Cosmetic results are excellent with almost invisible scars. There were 3 cases of intraoperative complication: incidental puncture of the iliac vein that required no treatment. There were 4 cases of postoperative complications: one case of ileus adhesion with bowel strangulation, and hernia recurrence in 3 boys, one of whom was reoperated with percutaneous internal ring suturing. In 5 boys, transient hydroceles were observed that disappeared spontaneously after 3 to 5 months.
Conclusion:
The percutaneous internal ring suturing method seems to be a simple and effective minimally invasive procedure with excellent cosmetic results. The rate of complications is comparable to other laparoscopic techniques of inguinal hernia repair in children. According to our experience, percutaneous internal ring suturing should be considered as a treatment alternative.