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Updated: Jan 14, 2026
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Laparoscopic-assisted extraperitoneal ligation versus intraperitoneal suturing for pediatric inguinal hernia repair:
Chaosheng He1, Yanbin Fang2, Yusheng Chen3
1Department of Pediatric Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.
Insights
Pediatric inguinal hernia repair using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) and two-port laparoscopic intracorporeal suturing (TPLIS) show similar low recurrence rates. Reoperation is effective for recurrent cases, with specific techniques advised for obese children and extended follow-up for TPLIS.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Pediatric inguinal hernia (PIH) repair is common.
- Recurrence is a significant concern following PIH repair.
- Comparing different laparoscopic techniques is crucial for optimizing surgical practice.
Purpose of the Study:
- To compare postoperative recurrence rates between laparoscopic-assisted extraperitoneal closure and intracorporeal suturing for pediatric inguinal hernia repair.
- To investigate the clinical causes of recurrence.
- To inform surgical practice and improve patient outcomes.
Main Methods:
- Retrospective review of 5244 single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) repairs and 6054 two-port laparoscopic intracorporeal suturing (TPLIS) repairs.
- Follow-up period of 2 years for all patients.
- Analysis of intraoperative findings at reoperation and causes of recurrence.
Main Results:
- Recurrence rates were not statistically significantly different between SPLPEC (30 cases) and TPLIS (35 cases).
- Primary causes of recurrence included omitted/torn peritoneum, abdominal wall lipidosis, and loose knots.
- Reoperation was successful in most cases, with no further recurrences in the SPLPEC group post-reoperation.
Conclusions:
- Both SPLPEC and TPLIS demonstrate low recurrence rates in pediatric inguinal hernia repair.
- The incidence of PIH in females may be underestimated.
- Secure ligation is essential for SPLPEC in obese children; TPLIS requires extended follow-up.
Background:
This study aimed to retrospectively compare postoperative recurrence rates between laparoscopic-assisted extraperitoneal closure and intracorporeal suturing for pediatric inguinal hernia (PIH) repair across multiple centers, and to investigate the clinical causes of recurrence to inform surgical practice.
Methods:
This is a retrospective review of 5244 PIH repairs performed using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) at the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University between January 2017 and December 2020. In addition, 6054 PIH repairs were performed using two-port laparoscopic intracorporeal suturing (TPLIS) at the Capital Center for Children's Health, Capital Medical University between January 2015 and December 2020. All patients were followed for 2 years with intraoperative findings at reoperation documented and causes of recurrence analyzed.
Results:
There was recurrence in 30 SPLPEC cases (27 males, 3 females; mean interval to recurrence, 7.6 months). There was a recurrence in 35 TPLIS cases (31 males, 4 females; mean interval, 12.5 months). There was no statistically significant difference in recurrence rates (p=0.966). Laparoscopic re-exploration identified omitted or torn peritoneum (n=42), lipidosis in the abdominal wall (n=7), and loose knots (n=16) as the primary causes of recurrence. No further recurrences were seen in the SPLPEC group after reoperation. In the TPLIS group, 33 patients had favorable outcomes, 2 patients experienced a second recurrence.
Conclusions:
The incidence of PIH in females may be higher than previously recognized. Both SPLPEC and TPLIS demonstrated low recurrence rates, particularly among females and the second operation proved to be an effective treatment option for recurrent cases. For SPLPEC in obese children, secure ligation of the hernia internal ring is essential to prevent recurrence. TPLIS requires extended follow-up to detect possible late recurrence.
