title: Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia.
abstract: BACKGROUND
  Laparoscopic procedures for pediatric inguinal hernia (PIH) have numerous techniques and continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) with variable devices seems to be one of the most simple and reliable methods. Here the authors describe and evaluate the applicable effects of SPLPEC using an innovative two-hooked core hernia apparatus.
  
  
  METHODS
  Between June 2008 and October 2011, 72 children with indirect inguinal hernia underwent SPLPEC with an innovative two-hooked core hernia apparatus. A 5-mm laparoscope was placed through a transumbilical port. Without an assistant working port, the two-hooked core hernia apparatus with a 2-0 nonabsorbable suture was inserted at the point of the internal inguinal ring. It could be readily kept in an identical subcutaneous path for introducing and withdrawing the suture. The extraperitoneal knot-tying could tautly enclose the hernia defect without peritoneal gaps and upper subcutaneous tissues. During the same period, 63 cases with PIH underwent SPLPEC with a single-hooked hernia device. Technical essentials, mean operation time, and intra- and postoperative complications were compared.
  
  
  RESULTS
  The internal orifice was closed faster by SPLPEC with the innovative two-hooked core apparatus than with a single-hooked device (unilateral, 13.21±3.86 versus 17.92±4.37 minutes [P<.05]; bilateral, 17.18±4.69 versus 25.36±7.38 minutes [P<.01]). There were no postoperative complications or evidence of early recurrence in the two-hooked group. However, one recurrence and one subcutaneous knot granuloma were postoperatively observed in the single-hooked group.
  
  
  CONCLUSIONS
  SPLPEC with the two-hooked core apparatus was proved to be a successful procedure without leaving a peritoneal gap and ligating subcutaneous tissues. It is safe, feasible, and reliable for PIH.
authors.affiliation: Department of Pediatric Surgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Suolin
authors.initials: S
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Meng
authors.initials: M
authors.lastname: Li
mesh_terms: D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome