title: Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience.
abstract: BACKGROUND
  Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus.
  
  
  OBJECTIVE
  To evaluate the usefulness of the PIRS technique.
  
  
  METHODS
  Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010.
  
  
  RESULTS
  In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery.
  
  
  CONCLUSIONS
  Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery).
authors.affiliation: Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland ; Department of Pediatric Surgery, Urology and Traumatology, Wladyslaw Buszkowski Children's Hospital, Kielce, Poland.
authors.forename: Przemysław K
authors.initials: PK
authors.lastname: Wolak
authors.affiliation: Department of Surgery and Pediatric Urology, University of Medicine, Wroclaw, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowski
keywords: children; inguinal hernia; laparoscopic hernia repair; laparoscopic surgical technique; percutaneous internal ring suturing
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