Initial Experience with Laparoscopic Percutaneous Repair of Indirect Inguinal Hernia in Adolescents and Adults

Purpose: High ligation of the patent processus vaginalis (PPV) as basis of the treatment of indirect inguinal hernia in pediatric patients is not applied to adults. Instead, the popular options are the laparoscopic transabdominal preperitoneal (TAPP) approach or totally extra peritoneal (TEP) approach. We developed a unique technique to achieve laparoscopic completely extra peritoneal closure (LPCEC) of the PPV and have applied it to adolescent and adult patients on patient’s demand. The purpose of this paper is to introduce our initial experience with LPCEC in adolescents and adults and evaluate their outcomes. Material and methods: This report includes 20 patients over 15 years of age with indirect inguinal hernia consecutively experienced since 2004. The medical records of these patients were analyzed in terms of intra operative findings of the internal inguinal ring (IIR), rates of contralateral patent processus vaginalis (cPPV), operation time, complications, postoperative recurrence rates, and rates of metachronous contralateral inguinal hernia (MCIH). Results: There were 13 males and 7 females; 11 with right unilateral, seven with left unilateral and two with bilateral hernias. Ages ranged from 15 years to 67 years with an average of 23.4 years. Three males had an episode of open herniorrhaphy on the contralateral side during childhood. One male patient had a direct hernia on the contralateral groin. The two oldest patients were associated with omental incarceration. One male presented with bowel loop incarceration. The procedures were completed successfully without complications in all of the patients. The mean operation time was 45 minutes for unilateral and 53 minutes for bilateral hernia, respectively. No recurrence and MCIH has been noted. No patients reported postoperative chronic groin pain. Conclusions: The advantages of our LPCEC include technical ease, short operation time, minimal invasion, preservation of reproductive systems, rapid return to daily activities and low recurrence rate. The LPCEC is a feasible alternative to the TAPP and TEP for the repair of inguinal hernia in adolescents and adults, when the diagnostic laparoscopy via umbilical port defines the inguinal hernia as indirect.