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Technical refinements of pediatric laparoscopic percutaneous extraperitoneal closure for adult indirect inguinal
Shoko Kato1, Takuya Saito2,3, Kenitiro Kaneko1
1Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
Insights
Laparoscopic percutaneous extraperitoneal closure (LPEC) can be adapted for adult inguinal hernias with technical refinements. However, careful patient selection is crucial, especially avoiding cases with preoperative bowel protrusion to prevent recurrence.
Area of Science:
- Minimally Invasive Surgery
- Surgical Techniques
- Hernia Repair
Background:
- Laparoscopic percutaneous extraperitoneal closure (LPEC) is standard for pediatric inguinal hernias.
- Adult LPEC presents challenges due to thicker abdominal walls and deeper ligation planes.
Purpose of the Study:
- To describe technical refinements for adapting pediatric LPEC to adult indirect inguinal hernias.
- To identify patient selection criteria and cautionary findings for adult LPEC.
Main Methods:
- Evaluation of 20 adult patients undergoing LPEC for indirect inguinal hernia.
- Implementation of technical refinements: double ligation, enlarged puncture sites, tension reduction, and needle-route straightening.
Main Results:
- Successful LPEC completion in selected adults, including those with high BMI and thick abdominal walls.
- Two recurrences were observed, both in patients with preoperative bowel protrusion.
Conclusions:
- Pediatric LPEC technique can be modified for selected adult patients with appropriate refinements.
- Preoperative bowel protrusion is a significant cautionary factor for adult LPEC indication.
Purpose:
Laparoscopic percutaneous extraperitoneal closure (LPEC) is an established procedure for pediatric inguinal hernia repair. In adults, however, its application is technically more demanding because of a thicker abdominal wall, greater tissue resistance, and a deeper ligation plane. Based on our standardized pediatric LPEC technique, we describe technical refinements for adult indirect inguinal hernias and examine an important cautionary finding related to patient selection.
Methods:
Among adults with suspected indirect inguinal hernia treated between 2023 and 2025, 20 patients who underwent LPEC were evaluated. For adult cases, we incorporated several technical refinements, including double ligation, puncture-site enlargement, tension reduction during ligation, and needle-route straightening.
Results:
The procedure was completed in selected adults, including those with a high body mass index and greater abdominal wall thickness. Recurrence occurred in two patients, both of whom had preoperative bowel protrusion. This finding suggests that bowel protrusion should be regarded as an important cautionary feature when considering the indication for adult LPEC.
Conclusion:
Standardized pediatric LPEC may be adapted for selected adults when appropriate technical refinements are applied. However, cases with preoperative bowel protrusion require particularly careful judgment when determining indication.