Inguinal hernia: Laparoscopic repair

Abstract

Laparoscopic percutaneous extraperitoneal closure (LPEC), an extracorporeal approach, is the most common procedure in the Japanese pediatric surgeons. After a 30° 5 mm laparoscope is inserted through the umbilical trocar, 2 mm grasping forceps is inserted via the lateral abdominal wall to manipulate the peritoneum near the internal inguinal ring. The contralateral side is observed not to overlook a slit-type or covered internal inguinal ring. The internal orifice of the inguinal canal is closed with purse-string suture of 2-0 nonabsorbable suture thread using a special needle with a wire loop to hold the suture thread at the tip. After dissection of the testicular vessels and vas deferens, the suture thread is released from the tip of the needle, the direction of the needle turned medially to put the purse-string suture on the medial half of the internal inguinal ring using the same technique. Before ligation, we have to confirm that there is no gap or skip lesion of the suture and that there is no involvement of the testicular vessels or vas deferens. The purse-string suture is tied extracorporeally. Contralateral PPV is closed using the same approach.