Can Percutaneous Internal Ring Suturing Procedure Take the Place of Open Method in the Surgical Treatment of Girls with Inguinal Hernia?

Percutaneous internal ring suturing (PIRS) method for inguinal hernia (IH) repair in girls is increasingly used in clinics especially experienced in minimal invasive surgery. We aimed to evaluate and compare our results of laparoscopic PIRS and the open procedure for IH repair in girls in our series.

We retrospectively evaluated female patients in our pediatric surgery clinic who underwent IH surgery between 2012 and 2017 and results were assessed statistically.

We identified 293 girls operated in our clinic with IH. In 164 of them, PIRS procedure (group 1) was performed; 73 had right, 26 had left, and 65 (39.6%) had bilateral IH. Among these 65 patients, 16 had only right and 11 had only left IH according to preoperative examination, which turned out to be bilateral during laparoscopy. In the open surgery group (Group II), there were 129 patients. Seventy-eight patients had right, 38 had left, and 13 (10%) had bilateral IH. Sliding fallo-pian tubes were present in seven of Group I versus 21 of group II (p<0.001), while sliding ovaries were present in seven of Group I versus 16 of Group II (p=0.015). Recurrence was observed in only one patient in Group I (p>0.05).

The higher rate of bilaterality is still the problem for laparoscopic procedures. Despite over-diagnosis, no more complications were not detected due to PIRS. High ratio of sliding tubes and ovaries can be due to traction for preparing the sac in open surgery. Hematoma can be a serious problem to complete PIRS procedure. Preferred technique from the surgeon's point of view is in favor of PIRS procedure. In addition, PIRS pro-cedure can be more protective for internal genitalia, but more studies with higher numbers and longer follow-up period are needed.