A simple single-port laparoscopic-assisted technique for completely enclosing inguinal hernia in children

Single-port endoscopic-assisted percutaneous extraperitoneal closure of inguinal hernia with variable devices is a novel technique in minimal-access surgery for pediatric inguinal hernias. However, a small peritoneal gap of the suture at the location of spermatic vessels and vas deferens may be left untouched, whereas some subcutaneous tissues, including nerves and muscles, may cause injury by their inclusion in the upper portion of the circuit suturing. The technique may fail to entirely enclose the hernia defect and has the potential to lead to higher incidence of hydrocele and hernia recurrence. The authors describe the modification of single-port endoscopic-assisted ligation with a homemade hooked injection needle, which is designed to cause hydrodissection to the preperitoneal space, tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and aid in the achievement of a near-zero recurrence rate.