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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Laparoscopic needle-assisted inguinal hernia repair in 495 children
Lauren McClain1, Christian Streck, Aaron Lesher
1Division of Pediatric Surgery, Medical University of South Carolina, Charleston, SC, USA, mcclail@musc.edu.
Insights
Laparoscopic needle-assisted repair (LNAR) offers a safe and effective minimally invasive option for pediatric inguinal hernias, comparable to open surgery. This technique demonstrates low complication and recurrence rates, with potential benefits like identifying contralateral defects.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Laparoscopic Techniques
Background:
- Pediatric inguinal hernia repair via minimally invasive surgery remains a debated topic among surgeons.
- Traditional open repair methods have been the standard, but laparoscopic approaches are gaining traction.
Purpose of the Study:
- To describe and evaluate the safety and efficacy of a specific laparoscopic needle-assisted repair (LNAR) technique for pediatric inguinal hernias.
- To compare the outcomes of LNAR with established open surgical methods.
Main Methods:
- A review of a prospectively collected outcomes database for 502 pediatric cases (710 hernias) undergoing LNAR between 2009 and 2013.
- The LNAR technique involves a single-port, needle-assisted approach to encircle the internal ring with a purse-string suture in an extraperitoneal plane.
Main Results:
- The study included 495 patients (11 days to 12.8 years old) with 710 inguinal hernias repaired using LNAR.
- Mean operating times were 20.5 minutes for unilateral and 26.4 minutes for bilateral repairs.
- A total of 21 minor complications (4% rate) and 4 recurrences (0.56%) were observed, comparable or superior to open techniques.
Conclusions:
- Laparoscopic needle-assisted repair (LNAR) is a safe and effective minimally invasive technique for pediatric inguinal hernias.
- LNAR offers advantages including objective identification of contralateral defects and reduced risk of cord structure injury.
- The observed recurrence rate of 0.56% supports LNAR as a viable alternative to open repair.
Abstract:
Minimally invasive surgery for inguinal hernia repair in children has been a controversial topic for pediatric surgeons. Our method for inguinal hernia repair using laparoscopic techniques has comparable outcomes to the standard open technique. We describe our technique and experience with the laparoscopic needle-assisted repair of inguinal hernia (LNAR). We report 502 cases (710 hernias) from 2009 to 2013 by 3 surgeons. We reviewed our prospectively collected outcomes database of all patients receiving LNAR from 1/2009 to 3/2013. 502 cases in 495 patients <13 years old with 710 inguinal hernias were identified for analysis and review. Hernia repair is accomplished with a single-port needle-assisted technique. After identification of a patent processus vaginalis, the internal ring is encircled in an extraperitoneal plane using a 22G-Touhy needle for placement of a purse-string suture, tied extracorporally, and buried beneath the skin. The technique was standardized for all cases. 710 inguinal hernias were laparoscopically repaired in 495 patients (408 boys and 87 girls) age range 11 days to 12.8 years (mean 29.2 months; median 15.5 months). 294 patients had unilateral repair (199R and 95L) and 208 had bilateral repair. Mean operating time for unilateral was 20.5 min, and bilateral was 26.4 min. 21 minor complications were identified (9 superficial wound infections, 8 suture granulomas, and 4 recurrent hydroceles) and 4 recurrences. Mean time since surgery is 30 months (3-54 months). Mean follow-up was 10.7 months (0.3-38.4 months). Post-operative data show our technique is safe with a 4 % rate of minor complication. Recurrence rate was 0.56 % for the total number of hernias (4/710). This recurrence rate is comparable and in many cases less than open technique. Furthermore, laparoscopy objectively identifies asymptomatic or occult contralateral defect, uses a smaller incision, and eliminates dissection of the cord structures potentially reducing the risk of cord injury.
