Related Experiment Video
Updated: Dec 28, 2025
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Modified percutaneous internal ring suturing with peritoneal injury in children: matched comparison to open hernia
Raghavendra Rao1, Michael Smith2, Troy A Markel3
1Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, 805 Riley Hospital Drive, Indianapolis, IN, 46202, USA. srrao84@icloud.com.
Insights
Percutaneous internal ring suture (PIRS) with thermal injury shows comparable outcomes to open inguinal hernia repair (OHR) in pediatric patients. This minimally invasive technique offers similar safety and efficacy for inguinal hernia treatment.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Hernia repair
Background:
- Inguinal hernias are common in pediatric patients.
- Open inguinal hernia repair (OHR) is a traditional method.
- Percutaneous internal ring suture (PIRS) with thermal peritoneal injury is an emerging technique.
Purpose of the Study:
- To compare the outcomes of PIRS with thermal injury versus OHR in pediatric inguinal hernia repair.
- To evaluate recurrence and complication rates between the two surgical techniques.
- To assess the safety and efficacy of PIRS in a large contemporary pediatric cohort.
Main Methods:
- Retrospective review of PIRS and OHR procedures between January 2017 and September 2018.
- 1:1 Propensity score matching based on patient and hernia characteristics.
- Analysis of recurrence, complication rates, and operative time.
Main Results:
- 90 PIRS patients were matched with 90 OHR patients.
- No significant differences in recurrence (PIR=1, OHR=3) or complication rates (PIR=4, OHR=1).
- Contralateral patent processus vaginalis (PPV) detection and repair rates were similar between PIRS (25.6%) and OHR (9.4% of all OHR).
Conclusions:
- PIRS with peritoneal injury demonstrates comparable efficacy and safety to OHR for pediatric inguinal hernia repair.
- Experience may further improve recurrence and complication rates for PIRS.
- Long-term outcomes of PIRS require further investigation.
Background:
The aim of this study was to elucidate the outcomes of percutaneous internal ring suture (PIRS) technique for inguinal hernia repair augmented with thermal peritoneal injury compared to open inguinal hernia repair (OHR) in a large population of contemporary pediatric patients. Thermal injury with PIRS has been shown to reduce recurrence in animal models and is increasingly being incorporated into clinical practice.
Methods:
Retrospective review of all PIRS procedures and OHR between Jan-2017 to Sept-2018 was performed. Data regarding patient characteristics, characteristics of the hernia, operative details, postoperative complications, and recurrence were collected. Non-parametric tests were used and p < 0.05 was regarded as statistically significant. 1:1 Propensity score matching was performed using "nearest-score" technique. Matching was done based on age, sex, follow-up time, side of hernia, repair of contralateral hernia, and number of additional procedures.
Results:
90 modified PIRS patients were matched to 90 OHRs. Patient demographics, hernia characteristics, and follow-up time were similar between the two groups after matching. There were no differences in recurrence rates (1 vs. 3 in OHR and PIRS, respectively, p = 0.6), complication rates (1 vs. 4 in OHR and PIRS, respectively, p = 0.4), and OR time [44.5 vs. 43 min in OHR and PIRS, respectively, p = 0.8]. There were no intraoperative complications for either technique. For OHR, laparoscopic look was performed in 23%. When successful, it revealed a contralateral PPV (patent processus vaginalis-PPV) in 41% of cases (9.4% of all OHR), all of which were repaired. For the PIRS procedures, a contralateral PPV was found in 25.6%, all of which were repaired. In the unmatched population, OHR had a metachronous hernia rate of 1.8%, none of whom had the contralateral PPV repaired at the original procedure.
Conclusions:
PIRS with peritoneal injury has comparable efficacy and good safety compared to OHR. Recurrence and complication rates should further improve with increasing experience. Future studies should elucidate long term outcomes.
