title: Single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia in children and adolescents: case series.
abstract: Femoral hernias are an often unexpected groin pathology during childhood. However, the pediatric surgeon has to be aware to diagnose femoral hernia and to repair this condition. This is the first report on laparoscopic percutaneous extraperitoneal closure of femoral hernia (LPEF) in children and adolescents.
  
  
  
  Over a 6-year period in a bi-institutional clinical study, we retrospectively identified six children and one young adult who underwent LPEF repair.
  
  
  
  Femoral hernia was laparoscopically confirmed in seven patients. Ages at surgery were 3, 5, 7, 7, 8, 8.5, and 18 years, respectively. In the first case, we combined laparoscopic diagnosis with open repair. In the consecutive six cases, hernias were repaired minimally invasively with the percutaneous extraperitoneal technique described below. During a follow-up between 6 years and 6 months, no recurrence was observed.
  
  
  
  For LPEF, we percutaneously placed a peritoneal U-shape suture with integrated transfixation of the hernia sac, closed with an epifascial knot. We performed LPEF using two graspers. The peritoneum was percutaneously punctured with a venous cannula through which the suture was inserted. One grasper was inserted through the working channel of the laparoscope to invert the hernia sac into the abdominal cavity. A mini-grasping forceps inserted through the cannula retrieved the thread and completed LPEF.
  
  
  
  We demonstrate that single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia is successful and quick in children and in adolescents.
authors.affiliation: Department of Pediatric Surgery, Marienhospital Herne, St. Elisabeth-Group, Ruhr-University of Bochum, Widumer Strasse 8, 44627, Herne, Germany. ralf-bodo.troebs@elisabethgruppe.de.
authors.forename: R-B
authors.identifier: 0000-0003-0406-5584
authors.initials: RB
authors.lastname: Tröbs
authors.affiliation: Clinic for Surgery and Pediatric Surgery, Friedrich-Ebert-Straße 13, 33602, Bielefeld, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Yilmaz
authors.affiliation: Department of Pediatric Surgery, Marienhospital Herne, St. Elisabeth-Group, Ruhr-University of Bochum, Widumer Strasse 8, 44627, Herne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bahr
authors.affiliation: Department of General, Visceral and Tumor Surgery, University of Cologne, Kerpener Str. 26, 50937, Cologne, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Cernaianu
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, Klinikum der Stadt Köln, Amsterdamer Str. 59, 50735, Cologne, Germany.
authors.forename: R M
authors.initials: RM
authors.lastname: Vahdad
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006550:Hernia, Femoral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D010537:Peritoneum / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Femoral hernia; Laparoscopic closure; Pediatric