Page 23 - World Journal of Laparoscopic Surgery

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Fig. 5: Needle is withdrawn leaving the suture loop in situ • Now the internal ring is reinspected (Figs 10 and 11).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