A Modified Technique with a New Device of Laparoscopic Percutaneous Extraperitoneal Closure for Pediatric Inguinal Hernia.
BACKGROUND
Laparoscopic percutaneous extraperitoneal closure (LPEC) in boys is more complex than in girls, because the vas deferens and testicular vessels must be separated from the peritoneum. We therefore developed a needle-shaped surgical instrument that enables blunt separation. Here, we report the effectiveness of this new device.


METHODS
The new device is a ligature carrier consisting of (1) an inner tube (19-G blunt needle) through which slides a rod with a loop wire at its tip that can catch and release suture materials and (2) an outer tube (17-G needle) with a cutting edge. The blunt-structured inner tube enables blunt separation. All actions (stabbing, separation, and catching) in the LPEC procedure that are required to close the hernia orifice using a thread are facilitated through a simple small incision by switching between the inner and outer tubes.


METHODS
From January 2013 to September 2015, 73 boys with inguinal hernia or hydrocele underwent LPEC, and the new device was used in 45 of these cases. We compared surgical results between cases wherein the new (group A) and conventional devices (LPEC needle; group B) were used.


RESULTS
The mean surgery duration was 33.4 and 34.8 min for groups A and B, respectively. Neither group experienced complications during or after surgery.


CONCLUSIONS
Our findings suggest that the newly developed needle device may improve the safety of the LPEC procedure for boys, although further investigation involving more cases and long-term follow-up is needed in the future.
1 Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital , Kofu, Japan .
Takaki
T
Emura
2 Department of Pediatric Surgery, Yamagata Prefectural Central Hospital , Yamagata, Japan .
Hiroshi
H
Ohta
1 Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital , Kofu, Japan .
Noboru
N
Oyachi
1 Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital , Kofu, Japan .
Takeyuki
T
Suzuki
D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009339:Needles; D010537:Peritoneum / Q000601:surgery*; D013525:Surgical Instruments; D013536:Suture Techniques; D013537:Sutures; D006848:Testicular Hydrocele / Q000601:surgery*; D013737:Testis / Q000098:blood supply; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000295:instrumentation* / Q000379:methods; D014649:Vas Deferens
child; inguinal hernia; laparoscopy; percutaneous extraperitoneal closure