Page 104 - World Journal of Laparoscopic Surgeons

Ankit Shukla et al

Fig. 2: Suturing internal ring Fig. 3: Final closure of defect

The pneumoperitoneum was reduced and the umbilical having less chance of injury to cord structures, early
incision closed and patient was extubated. recovery, assessment of contralateral hernia and its
8
The patient recovered well, oral intake was started repair, and less postoperative pain. The advantage of
the same day, and she was discharged next day after percutaneous repair for inguinal hernia when compared
uneventful postoperative stay. with laparoscopic repair seems to be simple, quicker to
perform, economical, easy to learn, and cosmetically
DISCUSSION better with equal postoperative time and complication
9
Open herniotomy is the gold standard and the most rates. The recurrence rate in extraperitoneal repair is
10
commonly performed surgery for hernia in children, also less with some studies quoting it to be less than 1%.
3
and minimal invasive procedures are gaining interest. Looking at the various complications reported with
The inception of the idea of closure of internal ring for the procedure was injury to iliac vessels which was
4
inguinal hernia started way back in 1982, when Ger closed controlled with pressure after deflating the abdomen.
the internal ring with Michel clip for hernia in an adult Hydrocele was seen in few patients, but resolved and did
7
5
patient. Holcomb introduced the concept of diagnostic not require surgical management. The results of elec-
laparoscopy for the evaluation of contralateral inguinal tromyelography for the assessment of ilioinguinal nerve
region. Laparoscopic surgery for pediatric inguinal hernia entrapment were taken in 35 patients preoperatively and
commenced in late 1990s, which included three ports for postoperatively which were found to be normal. 10
intracorporeal ligation of the internal ring, but some sur-
geons refined this and preferred the two-port approach. 1,2 CONCLUSION
Further advancement in minimal invasive surgery This procedure was performed for the first time in our sec-
shifted the focus from intracorporeal suturing, which ondary care set-up with gratifying results for the patient,
was considered to be a difficult task, to extraperitoneal parents, and the operating team. Percutaneous internal
1
suturing of the indirect ring, leading to development of ring suturing under vision is a minimal invasive technique
various techniques with an identical goal of obliterating which is simple, effective, remarkably cosmetic, economi-
the internal ring in a minimal invasive way, namely PIRS, cal, easy to learn and reproduce with short operative time,
SEAL, modified SEAL, LASSO, single-incision pediatric and helpful in identifying occult contralateral hernia. The
endosurgery, extracorporeal with Reverdin needle, and complication and recurrence rates are quite low, making it
LPEC. 1-3,6 All these techniques use a single umbilical port a promising procedure of choice for congenital hernia and
for camera and different methods of percutaneous closure communicating hydrocele in the near future.
of internal ring under vision. The PIRS, the most popular
among these, uses an 18G needle, LASSO uses epidural REFERENCES
needle, and SEAL is accomplished with a curved needle
and a needle holder, whereas modified SEAL includes 1. El-Gohary MA. Laparoscopic ligation of inguinal hernia in
girls. Pediatr Endosurg Innov Techn 1997 Jan;1(3):185-187.
hydrodissection. 1,6,7 2. Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W.
Laparoscopic surgery for hernia when compared with Percutaneous internal ring suturing: a simple minimally
the traditional open herniotomy has an equal recurrence invasive technique for inguinal hernia repair in children.
rate of less than 4% with an edge over herniotomy by J Laparoendosc Adv Surg Tech A 2006 Oct;16(5):513-517.
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