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Published on: November 12, 2021
Pediatric inguinal hernia repair with a single-incision approach using an Endo Close™ suturing device
Ricardo Ordorica-Flores1, Rubén Figueroa-Portillo1, Fernando Pérez-Escamirosa2
1Department of Pediatric Surgery, Children's Hospital of Mexico Federico Gomez, Calle Dr. Márquez No. 162, Cuahtemoc, Doctores, 06720, Mexico, DF, Mexico.
Insights
This study introduces a new, single-incision technique for pediatric inguinal hernia repair using the Endo Close™ device. The method proved safe and effective, with no complications or recurrences in 34 patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Pediatric inguinal hernia repair traditionally uses extraperitoneal or intraperitoneal methods.
- Existing techniques have varying degrees of invasiveness and complexity.
- A need exists for simpler, more effective repair methods in children.
Purpose of the Study:
- To describe a novel, single-incision technique for pediatric inguinal hernia repair.
- To evaluate the safety and efficacy of this new method using the Endo Close™ suturing device.
- To present a minimally invasive approach with potential for improved patient outcomes.
Main Methods:
- A transumbilical laparoscopic approach was utilized.
- The Endo Close™ suturing device was employed through a single 3-mm incision.
- Percutaneous puncture and extraperitoneal dissection were performed to close the inguinal ring.
- Extracorporeal knot tying was performed for final closure.
Main Results:
- The procedure was performed on 34 pediatric patients (29 unilateral, 5 bilateral).
- Operative times were 10-15 minutes for unilateral and 25-30 minutes for bilateral repairs.
- Excellent cosmetic outcomes were achieved with minimal postoperative pain.
- A 12-month follow-up revealed no complications, recurrences, or instances of postoperative hydrocele.
Conclusions:
- The described technique offers a simple, safe, and reliable method for pediatric inguinal hernia repair.
- This novel approach demonstrates promising short-term results.
- Further long-term studies are warranted to fully assess the outcomes of this innovative technique.
Background:
Diverse techniques have been described for pediatric inguinal hernia repair, based on extraperitoneal [1-4] and intraperitoneal [5-8] methodologies. In this video, we describe a novel technique to repair pediatric inguinal hernia using an Endo Close™ suturing device by percutaneous puncture with a single incision.
Methods:
With a transumbilical approach, a 5-mm trocar is inserted for a 30° laparoscope. A 3-mm incision is made, and the Endo Close™ suturing device (Covidien, Minneapolis, MN, USA), with a 2-0 polypropylene suture retained by the stylet, is inserted perpendicularly to the skin. An extraperitoneal dissection is made on a side the inguinal ring and the needle of the device penetrates the peritoneum through the inferior border. Then, the stylet mechanism is pushed to free the lasso inside the cavity. At the same incision site, the needle of the Endo Close™ is inserted again, but an extraperitoneal dissection is made on the other side of the ring, ensuring that the needle penetrates at the same exit orifice. Now, the suture lasso is recovered and retracted to close the ring. Finally, the suture is extracted and knots are tied extracorporeally at the level of the skin.
Results:
A total of 34 patients (20 females and 14 males) underwent surgery with this procedure. Operative time for unilateral repair was 10-15 and 25-30 min for the bilateral repair (29 unilateral/5 bilateral). The patients experienced minimal postoperative pain. The follow-up period was 12 months with no complications, no recurrence and without cases of postoperative hydrocele. There were no injuries to the structures as vessels or vas deferens, and the esthetic outcome was excellent.
Conclusions:
The technique presents a simple, safe and reliable method to repair inguinal hernias in children. The long-term results of this novel technique will be evaluated in future studies.
