Page 106 - World Journal of Laparoscopic Surgeons

WJOL S
WJOLS

10.5005/jp-journals-10033-1334
Percutaneous Closure of Internal Ring
CASE REPORT

Percutaneous Closure of Internal Ring: A Leap Ahead

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1 Ankit Shukla, Varun Verma, Bhanu Gupta, Rajesh Chaudhary, Nishant Nayar
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ABSTRACT Patkowski et al from Poland introduced a simple
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Surgery for inguinal hernia is commonly performed in children. and easy method of suturing the internal ring percutane-
Traditional approach is open herniotomy. However, numerous ously with a needle under vision with a single umbilical
minimal invasive methods are evolving with the same or low port, naming it PIRS. Various techniques with an aim of
complication and recurrence rates. Percutaneous internal ring obliterating the internal ring in a minimal invasive way
suturing (PIRS) under vision is a minimal invasive technique
which is simple, effective, remarkably cosmetic, economi- have been introduced from time to time like subcutane-
cal, easy to learn and reproduce with short operative time, ous endoscopically assisted ligation (SEAL), modified
and helpful in identifying occult contralateral hernia. This SEAL, laparoscopically assisted simple suture oblitera-
procedure was performed first time in our secondary care tion (LASSO), laparoscopic percutaneous extraperitoneal
set-up with gratifying results for the patient, parents, and the
operating team. closure (LPEC), and transumbilical endoscopic surgery.
Keywords: Inguinal hernia, Laparoscopic, Laparoscopically CASE REPORT
assisted simple suture obliteration, Percutaneous internal ring
suturing. A 9-year-old female child presented to our surgery outpa-
How to cite this article: Shukla A, Verma V, Gupta B, Chaud- tient department with complaints of painless swelling in
hary R, Nayar N. Percutaneous Closure of Internal Ring: A Leap the right lower abdomen which appeared on coughing or
Ahead. World J Lap Surg 2018;11(1):51-53. while playing. On examination, a small reducible swelling
Source of support: Nil was noticed in the right groin. She was diagnosed with
Conflict of interest: None right-sided uncomplicated inguinal hernia and planned
for single-port laparoscopic surgery and PIRS under vision.
Patient was given general anesthesia with endo-
INTRODUCTION tracheal tube intubation and pneumoperitoneum was
Inguinal hernia surgery is performed in children quite created with the help of Veress needle maintaining a pres-
frequently. The classical and well-established approach sure of 8 to 10 mm Hg. Trocar was introduced through
is open herniotomy, necessitating a groin incision and lower aspect of the umbilicus for camera and abdomen
separating the sac from cord structures and ligating inspected from inside. A defect of approximately 2 cm
it at the internal ring. However, newer minimal inva- was found on the right side lateral to the inferior epigas-
sive techniques have evolved with time. Laparoscopic tric artery and left internal ring was obliterated. Percu-
repair of inguinal hernia in children was reported by taneous purse string suturing of the right internal ring
El-Gohary. Laparoscopic approach uses three ports was done under vision extraperitoneally with the help
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usually, but some experienced surgeons prefer two-port of needle and a nonabsorbable 2/0 suture (Figs 1 to 3).
approach, which requires intracorporeal ligation of the
internal ring.

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1,2 Surgeon, Anesthesiologist, Senior Resident, Radiologist
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1,2 Department of Surgery, Civil Hospital, Palampur, Himachal
Pradesh, India
3 Department of Anesthesiology, Civil Hospital, Palampur
Himachal Pradesh, India
4 Department of Surgery, Dr. Rajendra Prasad Government
Medical College, Kangra, Himachal Pradesh, India
5 Department of Radiology, Civil Hospital, Palampur, Himachal
Pradesh, India

Corresponding Author: Ankit Shukla, Surgeon, Department
of Surgery, Civil Hospital, Palampur, Himachal Pradesh, India
e-mail: nkitshukla@hotmail.com
Fig. 1: Right inguinal hernia defect
World Journal of Laparoscopic Surgery, January-April 2018;11(1):51-53 51