title: Laparoscopically assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children.
abstract: BACKGROUND
  Many different laparoscopic techniques for pediatric inguinal hernia (PIH) have been developed, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports. Single-port laparoscopic percutaneous extraperitoneal closure is one of the most simple and reliable methods. We describe our modifications of laparoscopically assisted simple suturing obliteration (LASSO) using an epidural needle with preperitoneal hydrodissection.
  
  
  METHODS
  Two hundred and seven patients with PIH were treated with single-port LASSO from February 2010 to July 2013. Under laparoscopic visualization, an 18-gauge epidural needle was inserted at the corresponding point of the internal ring. The hernia defect was obliterated extraperitoneally by a nonabsorbable suture that was introduced into the abdomen on one side and withdrawn on the opposite side in an identical subcutaneous path around the internal ring using the hydrodissection-lasso technique.
  
  
  RESULTS
  A total of 251 PIHs were successfully performed by LASSO, 163 patients had unilateral inguinal hernia repair, and 44 patients underwent repair of bilateral inguinal hernias. Mean operating time for unilateral and bilateral inguinal hernia repairs was 18.1±5.4min and 26.6±4.8min, respectively. There were no perioperative complications. Only one recurrence was observed to date.
  
  
  CONCLUSIONS
  LASSO using an epidural needle with preperitoneal hydrodissection as a handy technique has proved to be a safe and effective procedure. It is easy to perform with high parent satisfaction, invisible scarring, and good cosmetic results, and therefore is a worthy choice for PIH.
authors.affiliation: Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China. Electronic address: lisuolin@hotmail.com.
authors.forename: Suolin
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong SAR, China. Electronic address: kkywong@hku.hk.
authors.forename: Kenneth K Y
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Paul K H
authors.initials: PK
authors.lastname: Tam
mesh_terms: D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D020706:Laparoscopes; D008297:Male; D009339:Needles; D061646:Operative Time; D012008:Recurrence; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
keywords: Epidural needle; Inguinal hernia; Laparoscopically assisted simple suturing obliteration (LASSO); Single-port