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| J Korean Med Assoc > Volume 62(2); 2019 > Article |
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Yeajeong Kim, MB
Abstract
Inguinal hernia is one of the most common surgical disease that pediatric surgeons deal with. This article provides an overview of pediatric inguinal hernia and a review of the current evidence about variable laparoscopic operative options and their results. In recent years, the use of laparoscopic procedures has gained increased popularity. Most of the laparoscopic repairing methods for pediatric inguinal hernia have similar results with open surgery when it comes to recurrence rates and complication rates. They have shorter operative time for bilateral hernia, less contralateral metachronous hernia and less invasive for vas deference and testicular vessels. The laparoscopic repair can be an alternative of open repair. Further research comparing the different laparoscopic approaches including long term outcome will be needed.
References
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Figure 1
Percutaneous internal ring suturing technique. (A) Prepare the injection needle with non-absorbable thread inside the barrel of the needle. (B) Under laparoscopic-guided the needle is introduced into the body, with the movement of the tip of the under the peritoneum, over half of the internal ring including a part of the ligament and adjacent tissue. (C) The thread is pushed through the barrel of the needle into the abdominal cavity and eventually makes a loop. (D) The needle is pulled out, leaving the loop of the thread inside the abdomen. (E) The needle passes through the same skin puncture point, to surround the other half of the internal ring and the tip of needle pass through the loop. (F) One of the thread ends is introduced again into the barrel of the needle and the end of the thread goes through the barrel of the needle into the thread loop. (G) Next, the needle is withdrawn and the thread loop is pulled out of the abdomen with the thread end caught by the loop. The thread is placed around the inguinal ring and both ends exit the skin through the same puncture point. (H) The knot is tied to close the internal ring and is placed under the skin.
Figure 2
Laparoscopic percutaneous internal ring suturing technique. (A) Under laparoscopic guidance, a laparoscopic percutaneous extraperitoneal closure needle with a non-absorbable suture material is inserted percutaneously into the preperitoneal space at the corresponding skin of the internal ring. (B) Holding the end of thread with the forcep, pull the needle out a little bit. The needle is then introduced extraperitoneally in one side of the ring and extracted through the other side at the same skin incision. (C) Push the loop through the needle to make a loop larger inside abdominal cavity. Then put the end of thread to go through the loop. (D) Catching the end of the thread with the tightened loop. (E) Pull the needle with the thread out of the body. (F) Tie the suture externally to obliterate the internal ring.
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