title: A modification of the laparoscopic transcutaneous inguinal hernia repair to achieve transfixation ligature of the hernia sac.
abstract: OBJECTIVE
  The proposed benefits of laparoscopic inguinal hernia repair in the pediatric population include less postoperative pain, smaller scars, and easier access to the contralateral groin. This is countered by slightly higher recurrence rates reported in some series. These differences are attributable to variation in the laparoscopic technique, surgeon experience, and certain anatomic features. We describe a modification of the laparoscopic-assisted transcutaneous hernia repair that achieves transfixation ligature of the hernia sac and that may further reduce recurrence.
  
  
  METHODS
  Institutional review board approval was obtained, and a retrospective chart review of all patients undergoing repair of symptomatic hernias using this new technique was carried out. Data collection included demographics, laterality of hernia, operative time, recurrence rate, and complications.
  
  
  RESULTS
  Twenty-one patients (age 1-144 months) underwent hernia repair between October 2009 and October 2010 using a novel technique of transcutaneous transfixation ligature of the neck of the hernia sac. The mean operative time was 18 minutes (8-35 minutes). Follow-up was from 1 to 12 months. There was no intraoperative or postoperative complication and no recurrences to date.
  
  
  CONCLUSIONS
  The technique described is a modification of the existing laparoscopic-assisted transcutaneous inguinal hernia repair that more closely approximates the criterion standard open repair. The technique addresses some prevailing concerns with the initially described method of transcutaneous repair, and short-term outcomes are positive. Long-term outcomes remain to be defined.
authors.affiliation: Department of Surgery, Stanford University, Palo Alto, CA 94305, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kastenberg
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Dutta
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000517:prevention & control / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome