Inguinal herniotomy: Laparoscopic-assisted extraperitoneal technique

Abstract

Inguinal hernia is one of the most common surgical conditions in infants and children. Over the past few decades, inguinal exploration with clear dissection of the hernial sac off the vas deferens and spermatic vessels, and secure high ligation of the patent processus vaginalis (PPV), i.e. inguinal herniotomy, has remained the standard treatment. The procedure has stood the test of time with very low recurrence rates in experienced hands. However, there are continuing controversies regarding the management strategy for a possible contralateral patent processus vaginalis that may develop into a subsequent hernia. Routine exploration of the contralateral side, as has been adopted by some workers, may result in a significant proportion of unnecessary inguinal explorations, along with the potential complications (Wiener et al. 1996). Recently, it has become increasingly popular to examine the contralateral side laparoscopically through the open hernial sac and perform contralateral inguinal herniotomy should a patent processus vaginalis be present (Geisler et al. 2001; Holcomb et al. 1996; Miltenburg et al. 1998; Wulkan et al. 1996). However, at times the hernial sac may be too small or thin to allow passage of a laparoscope. A prominent peritoneal fold at the medial side of the contralateral deep ring may also significantly obscure the view of the laparoscope passed through the ipsilateral hernial sac. Transumbilical laparoscopy without doubt provides a better way to assess the status of the deep ring. We describe a new technique of endoscopic repair of inguinal hernia in children under the guidance of transumbilical laparoscopy. The technique is easy to learn and does not require expensive laparoscopic instruments. © Springer-Verlag Berlin Heidelberg 2008.