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Updated: Aug 29, 2025
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Comparison of laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure versus open repair
Shaofeng Wu1, Xiaoyu Xing1, Rong He1
1Department of Urology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, 1678 Dongfang Rd, Pudong District, Shanghai, 200127, China.
Insights
Laparoscopic percutaneous extraperitoneal closure (LPEC) is a safe and effective method for pediatric inguinal hernia repair, showing lower recurrence and metachronous contralateral inguinal hernia rates compared to open repair.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic-assisted repairs for pediatric inguinal hernia are increasingly accepted but lack consensus on optimal management.
- This study compares outcomes of a modified laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) versus traditional open repair.
Purpose of the Study:
- To compare the efficacy and safety of laparoscope-assisted single-needle LPEC versus open repair for pediatric inguinal hernias and hydroceles.
- To evaluate recurrence rates, incidence of metachronous contralateral inguinal hernia (MCIH), and other complications between the two surgical techniques.
Main Methods:
- Retrospective review of medical data for children undergoing LPEC or open repair (OR) for inguinal hernia between 2014 and 2019.
- Data collected included demographics, hernia laterality, surgical time, follow-up duration, recurrence, MCIH, and complications.
Main Results:
- Mean operative time was significantly shorter for LPEC (22.3 min) compared to OR (27.8 min) for bilateral repairs (p < 0.001).
- Postoperative recurrence rates were 0.5% for LPEC versus 1.3% for OR (p = 0.056).
- Iatrogenic cryptorchidism occurred more frequently in the OR group (0.4% vs. 0%, p = 0.013), and MCIH incidence was significantly lower in the LPEC group (0.3% vs. 3.7%, p < 0.01).
Conclusions:
- Laparoscope-assisted single-needle LPEC is a simple, effective option for pediatric inguinal hernia/hydrocele repair.
- LPEC demonstrates excellent outcomes, including low recurrence and significantly reduced metachronous contralateral inguinal hernia rates compared to open repair.
Background:
Laparoscopic-assisted repairs for pediatric inguinal hernia have gained gradual acceptance over the past decade. However, consensus about the optimal management is still lacking. The aim of this study is to compare outcomes of a modified laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) versus open repair of pediatric hernias/hydrocele in a single institution.
Materials And Methods:
We retrospectively reviewed the medical data of children who underwent laparoscope-assisted single-needle LPEC and open repair (OR) for inguinal hernia from 2014 to 2019. Data collection included demographics, laterality of hernia, surgical time and time to follow-up. We also reviewed and analyzed the evidence of recurrence, the incidence of metachronous contralateral inguinal hernia (MCIH), and other complications.
Results:
In our cohort, 961 patients in the OR group and 1098 patients in the LPEC group were analyzed retrospectively. Mean operative time was significantly shorter in the LPEC group (22.3 ± 3.5 min) than in the OR group (27.8 ± 5.9 min) for bilateral hernia repair (p < 0.001). Postoperative recurrence was 1.3% (13/1035) in the OR group and 0.5% (6/1182) in the LPEC group (p = 0.056). Iatrogenic cryptorchidism occurred statistically more frequently in the OR group than in the LPEC group (0.4% vs. 0%, p = 0.013). In addition, the incidence of MCIH was 3.7% (33/887) in the OR group and 0.3% (3/1014) in the LPEC group (p < 0.01).
Conclusion:
Comparing to open technique, laparoscope-assisted single-needle LPEC provides a simple and effective option for pediatric inguinal hernia/hydrocele repair with excellent outcomes, a low incidence of recurrence, and reduced MCIH.
