title: Laparoscopic Interrupted Muscular Arch Repair in Recurrent Unilateral Inguinal Hernia Among Children.
abstract: OBJECTIVE
  We present a procedure of suturing the transversus abdominis muscular arch to the ileopubic tract laparoscopically in order to repair recurrent unilateral pediatric inguinal hernia (PIH).
  
  
  METHODS
  Twenty-five children with recurrent unilateral PIH were treated during a 5-year period in a tertiary academic center. All cases were subjected to laparoscopic hernia repair and discharged the next morning. Sutures were placed from the muscular arch to the ileopubic tract, avoiding the spermatic vessels and duct, in an interrupted manner using 2/0-3/0 polypropylene (Prolene®; Ethicon, Somerville, NJ) or polyglactin 910 (Vicryl®; Ethicon) sutures. In 4 cases, a rectangular purse-string-like suture was added to narrow the internal ring defect. Operative findings and postoperative results and complications were assessed. The patients were followed up for a period that ranged between 6 and 60 months.
  
  
  RESULTS
  There were 23 boys and 2 girls. Operative age ranged between 18 months and 15 years. Three or four sutures were placed in each case. In 4 cases, an additional rectangular purse-string-like suture was added. Operative time ranged between 35 and 70 minutes, and there was no conversion. Mild scrotal edema was reported in 4 cases and port-site infection in 2 cases; all cases were treated conservatively. One case of recurrence among boys was reported, but there was no case of testicular atrophy. Cosmetic outcomes were excellent.
  
  
  CONCLUSIONS
  Laparoscopic interrupted muscular arch repair is a feasible and safe technique in the reconstruction of the inguinal canal in recurrent unilateral PIH. Larger studies and long-term follow-up are needed to support our encouraging results.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tanta University , Tanta, Egypt .
authors.forename: Sherif M
authors.initials: SM
authors.lastname: Shehata
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tanta University , Tanta, Egypt .
authors.forename: Akram M
authors.initials: AM
authors.lastname: ElBatarny
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tanta University , Tanta, Egypt .
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Attia
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tanta University , Tanta, Egypt .
authors.forename: Ashraf A
authors.initials: AA
authors.lastname: El Attar
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Tanta University , Tanta, Egypt .
authors.forename: AbdelGhani M
authors.initials: AM
authors.lastname: Shalaby
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D061646:Operative Time; D012008:Recurrence; D013536:Suture Techniques / Q000009:adverse effects