title: Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children.
abstract: BACKGROUND
  Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides.
  
  
  OBJECTIVE
  The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children.
  
  
  METHODS
  A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence.
  
  
  RESULTS
  
  
  
  CONCLUSIONS
  The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively. The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV.
  
  
  CONCLUSIONS
  Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time.
authors.affiliation: Benha University, Faculty of Medicine, Dept. of General Surgery, Egypt. Electronic address: hsurgeon71@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: mamar1973@yahoo.com.
authors.forename: M K
authors.initials: MK
authors.lastname: Youssef
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: dr_emadsalem@yahoo.com.
authors.forename: E A
authors.initials: EA
authors.lastname: Salem
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: amrfawzi_uro@hotmail.com.
authors.forename: A M
authors.initials: AM
authors.lastname: Fawzi
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: prof_esam_desoky@yahoo.com.
authors.forename: E A E
authors.initials: EA
authors.lastname: Desoky
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: ahmedeliwafarag@gmail.com.
authors.forename: A M
authors.initials: AM
authors.lastname: Eliwa
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: ahmedsakr_1980@yahoo.com.
authors.forename: A M N
authors.initials: AM
authors.lastname: Sakr
authors.affiliation: Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt. Electronic address: ashrf1959@gmail.com.
authors.forename: A M S
authors.initials: AM
authors.lastname: Shahin
mesh_terms: D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Children; High ligation; Laparoscopically assisted; Patent processus vaginalis