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Laparoscopic Herniotomy in Female Children: Our Experience in 110 Patients























            Fig. 1: Preloaded prolene into the spinal needle to make a loop  Fig. 2: Laparoscopic view of patent internal ring

























            Fig. 3: Insertion of preloaded suture loop into the pre peritoneum from   Fig. 4: Needle along with suture loop advanced under the peritoneum
            outside                                            around the lateral half of ring and entered the peritoneum at midpoint




                                                               •  Maintaining both ends of the preloaded suture extraperitoneal,
                                                                  advance the needle under the peritoneum around the lateral
                                                                  half of the internal ring (Figs 2 to 4).
                                                               •  Enter the peritoneum and advance the suture into the abdominal
                                                                  cavity, creating a loop (Fig. 4).
                                                               •  Remove the needle, leaving the loop in place (Fig. 5).
                                                               •  Advance the needle through the same skin puncture site around
                                                                  the medial half of the ring and enter the peritoneum at the
                                                                  same site of previous loop and pass the needle into the loop of
                                                                  previous suture (Fig. 6).
                                                               •  Pass prolene suture through barrel needle into the loop (Fig. 6).
                                                               •  Withdraw the needle leaving prolene suture in the loop (Fig. 7).
                                                               •  Catch the suture end of the loop outside the abdomen and
                                                                  withdraw them together, now the prolene thread is all around
                                                                  the internal ring (Fig. 8).
                                                               •  The abdomen is desufflated and any air or fluid in the sac is
                                                                  manually expressed with external compression and tie suture
                                                                  extracorporeally (Fig. 9).
            Fig. 5: Needle is withdrawn leaving the suture loop in situ  •  Now the internal ring is reinspected (Figs 10 and 11).




                                                        World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019)  69
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