Single-incision laparoscopic surgery for pediatric inguinal hernias using an epidural needle: A reliable and simpler operation method

Abstract

INTRODUCTION: Laparoscopic repairs for pediatric inguinal hernia have gained gradual acceptance in the past. The objective of this study was to evaluate the clinical efficacy and significance of singlesite laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle for children with inguinal hernia.

MATERIALS AND METHODS: We retrospectively analyzed clinical data of 529 children with inguinal hernia who underwent single-site laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle at our hospital from January 2019 to August 2024.

RESULTS: All micro-laparoscopic surgeries were successfully performed in the 529 patients, among them, a contralateral patent processus vaginalis was present in 208 patients with unilateral pathology and thus simultaneously repaired; a total of 737 cases of inguinal hernia were repaired. The average operating time was 13.42 ± 4.42min for unilateral hernioplasty and 19.20 ± 2.49min for bilateral hernioplasty. Only one male patient experienced a recurrence that required reoperation. In terms of postoperative complications, there were no surgical site infections, testicular atrophy, or abdominal adhesions. The mean follow-up time was 14.12 ± 3.45 months. All the patients had a small operative scar, which was minimally visible.

CONCLUSION: Single-port laparoscopic surgery using an epidural needle for children is a technically straightforward and reliable approach for treating pediatric inguinal hernias, characterized by high applicability, minimal postoperative complications, reduced recurrence risk, rapid convalescence, and superior aesthetic outcomes.

Keywords

Double-line band method / pediatric inguinal hernia / single-port laparoscopic surgery

References

[1] Kantor N , Travis N , Wayne C , Nasr A . Laparoscopic versus open inguinal hernia repair in children: Which is the true goldstandard? A systematic review and meta-analysis. Pediatr Surg Int 2019; 35: 1013- 26.

[2] Esposito C , Escolino M , Turrà F , Roberti A , Cerulo M , Farina A , et al. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 2016; 25: 232- 40.

[3] Jessula S , Davies DA . Evidence supporting laparoscopic hernia repair in children. Curr Opin Pediatr 2018; 30: 405- 10.

[4] Kozlov Y , Novozhilov V . Technology of single-incision laparoscopic surgery in treatment of inguinal hernia in small babies. J Laparoendosc Adv Surg Tech Part A 2015; 25: 526- 30.

[5] Helal AA . Laparoscopic single instrument closure of inguinal hernia in female children: A novel technique. J Pediatr Surg 2015; 50: 1613- 6.

[6] Chen P , Li S , Yu L , Jin S , Su J , Yang Z , et al. Single-port laparoscopic percutaneous extraperitoneal internal ring closure for paediatric inguinal hernia using a needle grasper. Pediatr Surg Int 2022; 38: 1421- 6.

[7] Yonggang H , Changfu Q , Ping W , Fangjie Z , Hao W , Zicheng G , et al. Single-port laparoscopic percutaneous extraperitoneal closure of inguinal hernia using "two-hooked" core needle apparatus in children. Hernia 2019; 23: 1267- 73.

[8] Zeng D , Pu C , Guo C , Kong X . Outcomes from a new modified single needle laparoscopic percutaneous extraperitoneal closure and cut off for pediatric inguinal hernia. Sci Rep 2024; 14: 12029.

[9] Davies DA , Rideout DA , Clarke SA . The International Pediatric Endosurgery Group evidence-based guideline on minimal access approaches to the operative management of inguinal hernia in children. J Laparoendosc Adv Surg Techn Part A 2020; 30: 221- 7.

[10] Chong AJ , Fevrier HB , Herrinton LJ . Long-term follow-up of pediatric open and laparoscopic inguinal hernia repair. J Pediatr Surg 2019; 54: 2138- 44.

[11] Zhang Y , Chao M , Zhang X , Wang Z , Fan D , Zhang K , et al. Does the laparoscopic treatment of paediatric hydroceles represent a better alternative to the traditional open repair technique? A retrospective study of 1332 surgeries performed at two centres in China. Hernia 2018; 22: 661- 9.

[12] Shalaby R , Abd Alrazek M , Elsaied A , Helal A , Mahfouz M , Ismail M , et al. Fifteen years experience with laparoscopic inguinal hernia repair in infants and children. J Laparoendosc Adv Surg Tech Part A 2018; 28: 101- 5.

[13] Shalaby R , Ismail M , Dorgham A , Hefny K , Alsaied G , Gabr K , et al. Laparoscopic hernia repair in infancy and childhood: Evaluation of 2 different techniques. J Pediatr Surg 2010; 45: 2210- 6.

[14] Son TN , Bao HV , Van NTH , Hiep PD , Mai DV , Quyet TV . Modifications of surgical techniques in laparoscopic percutaneous extraperitoneal closure of inguinal ring for childhood inguinal hernia to achieve zero recurrence and zero subcutaneous stitch granuloma. Pediatr Surg Int 2024; 40: 187.

[15] Luo H , Xu J , Chen J , Ni Z . Clinical efficacy of laparoscopic treatment of pediatric inguinal hernia: A meta-analysis. Am J Transl Res 2024; 16: 5155- 67.

[16] Shalaby R , Negm M , El-Sawaf M , Elsaied A , Shehata S , Hamed A , et al. Needlescopic disconnection and peritoneal closure for pediatric inguinal hernia repair: A novel technique. Surg Laparosc Endosc Percutan Tech 2022; 32: 272- 8.

[17] Korkmaz M , Güvenç BH . Comparison of single-port percutaneous extraperitoneal repair and three-port mini-laparoscopic repair for pediatric inguinal hernia. J Laparoendosc Adv Surg Tech 2018; 28: 337- 42.

[18] Thomas DT , Göcmen KB , Tulgar S , Boga I . Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases. J Pediatr Surg 2016; 51: 1330- 5.

[19] Thomas DT , Sag S , Kalyoncu Aycenk A , Tulgar S . Percutaneous internal ring suturing for inguinal hernia repair in children: Retrospective cohort of 714 patients with minimum 3-year follow-up. Medicina (Kaunas, Lithuania) 2024; 60: 1137.

[20] Svetanoff WJ , Fraser JA , Briggs KB , Staszak JK , Dekonenko C , Rentea RM , et al. A single institution experience with laparoscopic hernia repair in 791 children. J Pediatr Surg 2021; 56: 1185- 9.

[21] Kilda A , Berzanskis M , Lukosiute-Urboniene A , Malcius D , Barauskas V . High recurrence rate of children's inguinal hernia after percutaneous internal ring suturing: A single-center study. Hernia 2021; 25: 797- 801.

[22] Chang Y-T , Wang J-Y , Lee J-Y , Chiou C-S . A simple single-port laparoscopic-assisted technique for completely enclosing inguinal hernia in children. Am J Surg 2009; 198: e13- 6.

[23] Ozgediz D , Roayaie K , Lee H , Nobuhara KK , Farmer DL , Bratton B , et al. Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: Report of a new technique and early results. Surg Endosc 2007; 21: 1327- 31.

[24] Duan S , Zhang P , Lin X , Zheng L . Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement repair for pediatric inguinal hernia: A single-center experience with over 2,000 patients. Transl Pediatr 2021; 10: 1317- 23.

[25] Takehara H , Yakabe S , Kameoka K . Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: Clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg 2006; 41: 1999- 2003.

[26] Chen Y , Wang F , Zhong H , Zhao J , Li Y , Shi Z . A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Surg Endosc 2017; 31: 4888- 901.

[27] Wang C , Wang Y , Zhong M , Li R , Shen Z . Logistic analysis of the recurrence of laparoscopic percutaneous extraperitoneal repair of pediatric inguinal hernia: A report of 486 cases. Asian J Surg 2024; 47: 134- 9.

[28] Son TN , Bao HV . Long-term absorbable versus non-absorbable suture in laparoscopic percutaneous extraperitoneal closure of internal ring for inguinal hernia in children. J Pediatr Surg 2021; 56: 1127- 31.

[29] Kelly KB , Krpata DM , Blatnik JA , Ponsky TA . Suture choice matters in rabbit model of laparoscopic, preperitoneal, inguinal hernia repair. J Laparoendosc Adv Surg Tech Part A 2014; 24: 428- 31.

[30] Elbatarny AM , Khairallah MG , Elsayed MM , Hashish AA . Laparoscopic repair of pediatric inguinal hernia: Disconnection of the hernial sac versus disconnection and peritoneal closure. J Laparoendosc Adv Surg Tech Part A 2020; 30: 927- 34.

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press