Abstract
Purpose
This study was aimed to describe the technique of the modified trans-umbilical two-port laparoscopic suturing (M-TTLS), and show its feasibility and efficacy to treat pediatric inguinal hernia (PIH).
Methods
After general anesthesia, the patient was placed in the Trendelenburg position. Two trocars were set on umbilicus and a pneumoperitoneum was established at 8–12 mmHg. Under direct vision, a long syringe needle was punctured into the preperitoneal space above the internal inguinal ring (IIR). After the peritoneum separated by hydrodissection, the syringe needle was left in peritoneal cavity. A suture needle with 2–0 silk suture was periced into abdomen, and its tip was then inserted into the syringe needle hole by laparoscopic needle holder. Under the syringe’s guidance, the peritoneum on the surface of the vessels and vas was sutured intactly by a single stitch. Subsequently, the rest peritoneum was sutured continuously in a clockwise direction. After a purse-string suture completed, the orifice of hernia sac was closed intracorporeally by a single-instrument tie technique.
Results
Overall, 139 patients with PIH underwent M-TTLS, including 130 boys and 9 girls. Median age was 46.8 months. All procedures were performed uneventfully without conversion. Median operation time was 12 min for unilateral and 17 min for bilateral operations. There were three minor extraperitoneal hematomas occurred during the operation. After a median follow-up of 13 months, no common complications developed and no visible scars were observed on the abdominal wall.
Conclusions
M-TTLS is a safe and efficient scarless surgery for PIH repair.
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Acknowledgements
The authors would like to acknowledge Ningbo Municipal Bureau of Science and Technology for funding the study.
Funding
This work was supported by Ningbo Municipal Bureau of Science and Technology [Granting Number: 2016A610177; 2014B82003].
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Tiejun Shou, Hongji Zhong, and Furan Wang declare that they have no conflict of interest.
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All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in the study.
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Shou, T., Zhong, H. & Wang, F. Trans-umbilical two-port laparoscopic suturing of the inguinal hernia defect with percutaneous assistance: a safe and efficient scarless surgery for pediatric inguinal hernia repair. Hernia 22, 681–684 (2018). https://doi.org/10.1007/s10029-018-1749-5
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DOI: https://doi.org/10.1007/s10029-018-1749-5