Laparoscopic needle assisted extracorporeal repair of inguinal hernia in children: our experience

One of the most frequently performed operative procedures in pediatric age group is inguinal herniotomy. The traditional surgical approach is an exploration of the inguinal canal, dissection of the hernia sac from the spermatic cord and the hernia sac is closed at the level of the internal inguinal ring.1 To evaluate contra lateral defects during open inguinal hernia repair, laparoscopic telescope has been used for long time in paediatric age group.2 Since the first time of laparoscopic inguinal hernia repaired by El-Gohary, it has been performed in many institutions with a variety of methods.2,3 Although, laparoscopic inguinal hernia repair in children is getting popularity as a safe & feasible method, laparoscopic inguinal hernia repair in children is still a controversial topic.4,5 Usually the laparoscopic procedure is performed through three or, rarely, two ports in the abdominal wall and requires intra peritoneal suturing6,7 which is one of the most difficult technical aspects of laparoscopy. Even with adequate experience, Intra-abdominal suturing involves many manipulations with instruments inside the abdominal cavity and carries the risk of visceral injury.1 Recently, many authors suggested that laparoscopic hernia repair with extracorporeal ligation, as compared with intracorporeal suturing, results marked reduction in operative time, low recurrence rates, and excellent cosmetic results.8 In extracorporeal technique, the suture is placed through the puncture-point in the skin with an injection needle of various sizes and tied around the hernia sac at the level of the inguinal ring. The technique requires only umbilical port for telescope and some authors used a Maryland Forceps, introduced directly without any port, which leaves almost invisible scar.1,2,8,9 In our centre, we repair the defect in the internal inguinal ring using laparoscopic visualization and extracorporeal knot tying. The goal of this study is to evaluate our experiences of the laparoscopic needle assisted extracorporeal repair of inguinal Hernia in Children.