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Hernia

, Volume 18, Issue 3, pp 345–349 | Cite as

Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: a novel technique

  • W. Liu
  • R. WuEmail author
  • G. Du
Original Article

Abstract

Background

The development of laparoscopic processus vaginalis repair has provided an alternative approach to the management of inguinal hernia and hydroceles in children. Here we describe our new technique for laparoscopic extraperitoneal ligation of processus vaginalis with subumbilical single-port using a modified Kirschner pin.

Methods

A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision. A Kirschner pin with a hole in one flat terminal was inserted at the point of the internal inguinal ring. The processus vaginalis was closed extracorporeally by a non-absorbable suture, which was introduced into the abdomen through the Kirschner pin performing dissection within the extraperitoneal space in a series of movements. When a contralateral patent processus vaginalis is present, laparoscopic-assisted extracorporeal ligation is performed during the same operation.

Results

Between September 2010 and September 2012, 211 children (130 cases of inguinal hernia and 81 cases of hydrocele) underwent processus vaginalis repair using this novel technique. A contralateral patent processus vaginalis was present and thus simultaneously closed in 20 patients with unilateral inguinal hernias and 12 patients with unilateral hydroceles. The mean operative time was 18 min (8–35 min). The mean follow-up period is 12 months (range 5–24 months), and no recurrence and complications has been observed to date.

Conclusions

This article describes a unique technique of extracorporeal circuit ligation of processus vaginalis using a minimally invasive technique as afforded by a reused modified Kirschner pin. Single-port laparoscopic processus vaginalis repair using this instrument is feasible and seems to be safe.

Keywords

Single-incision laparoscopy Inguinal hernia Hydrocele Repair Children Technique 

Notes

Conflict of interest

All authors declare that they have no competing interest and no relevant financial interest.

References

  1. 1.
    Kapur P, Caty MG, Glick PL (1998) Pediatric hernias and hydroceles. Pediatr Clin North Am 45:773–789PubMedCrossRefGoogle Scholar
  2. 2.
    Potts WJ, Riker WL, Lewis JE (1950) The treatment of inguinal hernia in infants and children. Ann Surg 132:566–576PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Rodriguez WC, Rodriguez DD, Fortuno RF (1981) The operative treatment of hydrocele: a comparison of 4 basic techniques. J Urol 125:804–805PubMedGoogle Scholar
  4. 4.
    Tsai Y, Wu C, Yang S (2007) Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report. Surg Endosc 21:1623–1625PubMedCrossRefGoogle Scholar
  5. 5.
    Tsai YC, Wu CC, Yang SS (2008) Is local anesthesia or oral analgesics necessary after mini-laparoscopic functional surgery in children and young adults?: a prospective randomized trial. Surg Laparosc Endosc Percutan Tech 18:344–347PubMedCrossRefGoogle Scholar
  6. 6.
    Shalaby R, Ismail M, Dorgham A, Hefny K, Alsaied G, Gabr K, Abdelaziz M (2010) Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques. J Pediatr Surg 45:2210–2216PubMedCrossRefGoogle Scholar
  7. 7.
    Wilson JM, Aaronson DS, Schrader R, Baskin LS (2008) Hydrocele in the pediatric patient: inguinal or scrotal approach? J Urol 180:1724–1727PubMedCrossRefGoogle Scholar
  8. 8.
    Zahalsky MP, Berman AJ, Nagler HM (2004) Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol 171:2291–2292PubMedCrossRefGoogle Scholar
  9. 9.
    Schier F (2007) The laparoscopic spectrum of inguinal hernias and their recurrences. Pediatr Surg Int 23:1209–1213PubMedCrossRefGoogle Scholar
  10. 10.
    Gorsler CM, Schier F (2003) Laparoscopic herniorrhaphy in children. Surg Endosc 17:571–573PubMedCrossRefGoogle Scholar
  11. 11.
    SarangaBharathi R, Arora M, Baskaran V (2008) Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS 12:277–281Google Scholar
  12. 12.
    Niyogi A, Tahim AS, Sherwood WJ, De Caluwe D, Madden NP, Abel RM, Haddad MJ, Clarke SA (2010) A comparative study examining open inguinal herniotomy with or without hernioscopy to laparoscopic inguinal hernia repair in a paediatric population. Pediatr Surg Int 20:387–392CrossRefGoogle Scholar
  13. 13.
    Kuhry E, Van Veen RN, Langeveld HR, Steyerberg EW, Jeckel J, Bonjer H (2007) Open or total extraperitoneal inguinal hernia repair? A systemic review. Surg Endosc 21:161–166PubMedCrossRefGoogle Scholar
  14. 14.
    Nah SA, Glacomello L, Eaton S, de Coppi P, Curry JI, Drake DP, Kiely EM, Pierro A (2011) Surgical repair of incarcerated inguinal hernia in children. Laparoscopic or open? Eur J Pediatr Surg 2:8–11CrossRefGoogle Scholar
  15. 15.
    Schier F (2006) Laparoscopic inguinal hernia repair- a prospective series of 542 children. J Pediatr Surg 41:1081–1084PubMedCrossRefGoogle Scholar
  16. 16.
    Parelkar SV, Oak S, Gupta R, Sanghvi B, Shimoga PH, Kaltari D, Prakash A, Shekhar R, Gupta A, Bachani M (2010) Laparoscopic inguinal hernia repair in a pediatric age group-experience with 437 children. J Pediatr Surg 45:789–792PubMedCrossRefGoogle Scholar
  17. 17.
    Chan KL (2007) Laparoscopic repair of recurrent childhood inguinal hernias after open herniotomy. Hernia 11:37–40PubMedCrossRefGoogle Scholar
  18. 18.
    SarangaBharathi R, Arora M, Baskaran V (2008) Minimal access surgery of pediatric hernia: a review. Surg Endosc 22:1751–1762CrossRefGoogle Scholar
  19. 19.
    Rothenberg SS, Shipman K, Yoder S (2009) Experience with modified single port laparoscopic procedures in children. J Laparoendosc Adv Surg Tech A 19:695–698PubMedCrossRefGoogle Scholar
  20. 20.
    Chang YT (2010) Technical refinements in single port laparoscopic surgery of inguinal hernia in infants and children. Diag Ther Endosc 2010:392847Google Scholar
  21. 21.
    Tatekawa Y (2012) Laparoscopic extracorporeal ligation of hernia defects using an epidural needle and preperitoneal hydrodissection. J Endourol 26:474–477PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryProvincial Hospital Affiliated to Shandong UniversityJinanChina
  2. 2.Department of Pediatric SurgeryThe People’s Hospital of Linyi CityLinyiChina

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