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Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Diverse surgical techniques for laparoscopic transumbilical intraperitoneal suturing of the internal ring in male
Puneng Ma1, Yadong Li2, Xiaoling Huang1
1Department of Pediatric Surgery, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, 650100, China.
Insights
Three surgical techniques effectively repair inguinal hernias in pediatric males using laparoscopic transumbilical intraperitoneal repair. These methods address internal ring challenges, showing minimal complications and a 0% recurrence rate.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Inguinal hernia repair in pediatric males using a laparoscopic transumbilical approach can be complicated by excessive folds or scar tissue in the inguinal region.
- Suturing the internal ring in these cases requires specialized techniques to ensure successful repair.
Purpose of the Study:
- To evaluate the efficacy and safety of three distinct surgical techniques for laparoscopic transumbilical intraperitoneal repair of inguinal hernias in male pediatric patients with challenging internal ring anatomy.
- To compare the duration of internal ring suturing, complication rates, and recurrence rates among the techniques.
Main Methods:
- A retrospective study of 112 male pediatric patients undergoing laparoscopic transumbilical intraperitoneal inguinal hernia repair between January 2020 and March 2024.
- Three techniques were employed: needle-to-needle suturing, auxiliary suture-assisted suturing, and additional port-assisted suturing.
- Data collected included unilateral internal ring suturing duration, bleeding, complications, hospital stay, and six-month recurrence rates.
Main Results:
- All procedures were completed laparoscopically without conversion to open surgery.
- One instance of bleeding occurred with the needle-to-needle technique; no other complications were noted.
- Mean unilateral internal ring suturing times were 3.1±0.3 min (needle-to-needle, 47 cases), 2.8±0.2 min (auxiliary suture-assisted, 49 cases), and 2.2±0.3 min (additional port-assisted, 29 cases).
Conclusions:
- Needle-to-needle, auxiliary suture-assisted, and additional port-assisted techniques are clinically valuable for laparoscopic transumbilical intraperitoneal internal ring suturing in male pediatric inguinal hernia repair.
- These methods demonstrate safety and efficacy, with a 0% recurrence rate at six months.
- The choice of surgical approach should be individualized based on patient anatomy and surgeon expertise.
Abstract:
The presence of excessive folds or scar tissue in the inguinal region significantly complicates the intraperitoneal suturing of the internal ring when employing a laparoscopic transumbilical approach for repairing inguinal hernias in male pediatric patients. From January 2020 to March 2024, we utilized three distinct surgical techniques-needle-to-needle suturing, auxiliary suture-assisted suturing, and additional port-assisted suturing-to address the internal ring with excessive folds or scar tissue in 112 male pediatric patients who underwent laparoscopic transumbilical intraperitoneal repair for inguinal hernias at our hospital. For each technique, we recorded the duration of unilateral internal ring suturing as well as instances of bleeding, surgical complications, length of hospital stay, and recurrence rate. All procedures were successfully completed without conversion to open surgery. There was one instance of bleeding associated with the needle-to-needle technique used for internal ring suturing; however, no other complications were observed. The duration of unilateral internal ring suturing varied as follows: 3.1 ± 0.3 min for the needle-to-needle technique (47 cases), 2.8 ± 0.2 min for the auxiliary suture-assisted technique (49 cases), and 2.2 ± 0.3 min for the additional port-assisted technique (29 cases). All patients underwent day surgery, and there was a 0% recurrence rate at six months post-operation. Distinct surgical techniques-needle-to-needle suturing, auxiliary suture-assisted suturing, and additional port-assisted suturing-hold significant clinical value for laparoscopic transumbilical intraperitoneal suturing of the internal ring in male pediatric patients. The optimal surgical approach should be customized based on the patient's anatomy and the surgeon's expertise.
