Repair of indirect inguinal hernias by "laparoscopic joining of the edges".
OBJECTIVE
To evaluate a new laparoscopic technique for the treatment of indirect inguinal hernias.


METHODS
Using the rabbit model of indirect inguinal hernia, nitinol U-clips (Medtronic Inc, Minneapolis, MN) were applied to the edges of the internal inguinal ring to close the defect and induce a scar. The procedure required only a "needle-scope" and a 3-mm needle holder.


METHODS
Ten male New Zealand rabbits were divided in 2 groups: A=experimental (n=8 animals) and B=control (n=2 animals). Group A underwent laparoscopic placement of clips on day 1, with subsequent laparoscopic assessment on days 15, 30, and 60, and euthanized for histologic assessment on days 90 (n=4) and 120 (n=4). Group B underwent laparoscopy on day 0 (to confirm the presence of the hernias) and were euthanized on day 120.


RESULTS
All treated inguinal hernias developed a thick layer of fibrous tissue around the clips and were completely closed (8 out of 8). At day 15 after surgery, all clipped areas showed some fibrosis, and at day 30, the clips were totally covered by scar tissue. The fibrosis involved not only the clips, but also a surrounding area of 2 to 3 cm. Mean operative time was 39 minutes (from skin incision to skin closure), and the mean time for clip placement was 2 minutes.


CONCLUSIONS
The use of nitinol U-clips proved to be a simple, safe, and effective technique for the laparoscopic treatment of inguinal hernias in this animal model, which has a remarkable correlation with the anatomy of human pediatric indirect inguinal hernias.
Department of Pediatric Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA. laje@email.chop.edu
Pablo
P
Laje
William H
WH
Peranteau
Alan W
AW
Flake
D000818:Animals; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D023421:Models, Animal; D011817:Rabbits; D013525:Surgical Instruments