Inguinal hernia repair in children using single-incision laparoscopic-assisted percutaneous extraperitoneal closure.
OBJECTIVE
There are numerous techniques of minimally invasive surgery for pediatric inguinal hernia. However, laparoscopic percutaneous extraperitoneal closure (LPEC) is one of the most simple and reliable methods. Single-incision laparoscopic surgery has recently been developed to reduce the invasiveness of traditional laparoscopy. This study aimed to assess the safety and feasibility of the single-incision approach for LPEC.


METHODS
Between June 2009 and March 2010, 117 conventional LPEC and 60 single-incision LPEC (SILPEC) procedures were performed. A laparoscope was placed through a transumbilical incision. A 3-mm grasping forceps was inserted in the lower abdomen in LPEC and through the same transumbilical incision with a different entrance in SILPEC. Using the LPEC needle, the hernia sac was closed extraperitoneally. We compared the short-term outcomes of 177 children operated on using either technique.


RESULTS
Visualization and tissue manipulation were good in both methods. There were no complications or evidence of early recurrence. Cosmetically, SILPEC proved to be superior to LPEC because the scar resulting from surgical incision is hidden within the umbilicus.


CONCLUSIONS
Single-incision LPEC proved to be as successful an operative procedure as LPEC and produced excellent cosmetic results. Single-incision LPEC for inguinal hernia in children is safe and feasible.
Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan. uchida.hiroo@pref.saitama.lg.jp
Hiroo
H
Uchida
Hiroshi
H
Kawashima
Chikashi
C
Goto
Kaori
K
Sato
Mariko
M
Yoshida
Sinya
S
Takazawa
Tadashi
T
Iwanaka
D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome