Related Experiment Video
Updated: Aug 25, 2025
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Skipping the cord during laparoscopic percutaneous internal ring suturing in children, is it reasonable?
Ergun Ergun1, Beytullah Yagiz2
1Faculty of Medicine, Department of Pediatric Surgery, Ankara University, Dikimevi, 06100, Ankara, Turkey. drergunergun@gmail.com.
Insights
Skipping the peritoneum during laparoscopic percutaneous internal ring suturing (PIRS) for pediatric inguinal hernias is safe. This technique avoids spermatic cord and vessel damage without increasing recurrence or complication rates.
Area of Science:
- Pediatric surgery
- Minimally invasive procedures
- Surgical techniques
Background:
- Laparoscopic inguinal hernia repair in children is a minimally invasive option.
- Percutaneous internal ring suturing (PIRS) is a common technique.
- Concerns exist regarding potential spermatic cord or testicular vessel damage during PIRS.
Purpose of the Study:
- To compare recurrence and complication rates in pediatric inguinal hernia repair using PIRS.
- To evaluate the impact of skipping the peritoneum over the spermatic cord and/or vessels.
Main Methods:
- Retrospective analysis of patient charts for laparoscopic PIRS repairs (2017-2021).
- Video recording review to categorize hernias into 'skipped peritoneum' (Group 1) and 'not skipped' (Group 2).
- Comparison of recurrence and complication rates between the two groups.
Main Results:
- 101 boys underwent repair for 125 inguinal hernias.
- Group 1 (skipped peritoneum) had 63 hernias; Group 2 (not skipped) had 62 hernias.
- Both groups showed a 3% recurrence rate (2 cases each) with no other postoperative complications.
Conclusions:
- Skipping the peritoneum during PIRS is a safe approach.
- This technique effectively prevents spermatic cord and vessel damage.
- The method does not elevate recurrence or complication risks in pediatric inguinal hernia repair.
Background:
As a minimally invasive procedure, laparoscopic inguinal hernia repair in children was introduced. Percutaneous internal ring suturing (PIRS) is a popular technique. The main concern is that the spermatic cord will be trapped and/or the vasculature of the testes will be damaged in boys. This can be avoided by performing a careful dissection or by skipping the peritoneum over the cord and/or the vessels. The aim of the study was to compare the incidence of recurrence or complication (e.g. hydrocele) in children with skipped peritoneum on the cord and/or vessels compared to those without skipped peritoneum during laparoscopic PIRS repair.
Methods:
The charts of children who underwent laparoscopic PIRS repair for inguinal hernia between 2017 and 2021 were analyzed. Complications and recurrence were assessed. The video recordings were viewed, and data on skipping (group 1) or not skipping (group 2) the peritoneum on vas deferens was recorded. The rates of recurrence and complications were compared between groups.
Results:
There were 101 boys with a total of 125 inguinal hernias in the study. There were 45 right-sided hernias, 32 had left-sided hernias, and 24 had bilateral hernias. According to the video investigation, there were 63 hernias in group 1 and 62 hernias in group 2. In each group, there were two recurrences (3% for both groups). There were no other postoperative complications.
Conclusions:
To avoid spermatic cord or vessel damage, skipping the cord appears to be an acceptable path that does not appear to increase recurrence or complication rates while also ensuring the safety of spermatic structures.
