title: Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children.
abstract: BACKGROUND
  Laparoscopic herniorrhaphy in pediatric surgery is usually performed through three ports in the abdominal wall with intraperitoneal suturing. Our technique of percutaneous internal ring suturing (PIRS) requires only one umbilical port and needle puncture point. We describe the technique and evaluate the efficacy of percutaneous internal ring suturing for inguinal hernia repair in children.
  
  
  METHODS
  We performed percutaneous internal ring suturing on 106 children (ages 28 days-14.5 years) with 140 hernias. The procedures were performed under general endotracheal anesthesia. Pneumoperitoneum was established with an open technique. Under laparoscopic-guided vision an 18-gauge injection needle with a nonabsorbable thread inside the barrel of the needle was placed through the abdominal wall into the peritoneal cavity. By moving the injection needle, the thread passed under the peritoneum around the entrance into the hernia sac. The knot was tightened from outside and placed in the subcutaneous space. The contralateral open inguinal ring was closed in the same procedure.
  
  
  RESULTS
  The average operative time was 19 minutes for unilateral and 24 minutes for bilateral hernias. Follow-up ranged between 18 and 29 months. Cosmetic results are excellent with almost invisible scars. There were 3 cases of intraoperative complication: incidental puncture of the iliac vein that required no treatment. There were 4 cases of postoperative complications: one case of ileus adhesion with bowel strangulation, and hernia recurrence in 3 boys, one of whom was reoperated with percutaneous internal ring suturing. In 5 boys, transient hydroceles were observed that disappeared spontaneously after 3 to 5 months.
  
  
  CONCLUSIONS
  The percutaneous internal ring suturing method seems to be a simple and effective minimally invasive procedure with excellent cosmetic results. The rate of complications is comparable to other laparoscopic techniques of inguinal hernia repair in children. According to our experience, percutaneous internal ring suturing should be considered as a treatment alternative.
authors.affiliation: Department of Pediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland. dpat@chdz.am.wroc.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Czernik
authors.forename: Rafał
authors.initials: R
authors.lastname: Chrzan
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jaworski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Apoznański
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods; D008297:Male; D013536:Suture Techniques