One-Trocar Trans-Umbilical Laparoscopic Hernia repair with Intraperitoneal knot in Children

Author(s): Falchetti Diego, Corasaniti Lucia, Pellegrino Maristella, Argento Salvatore, Lanata Marco, Dessanti Antonio

Abstract

Background: Recently laparoscopic repair of pediatric inguinal hernia has been mainly oriented to video-assisted percutaneous ligation of peritoneal sac. Assessment of contralateral defect and a better cosmesis are recognized benefits of this procedure, however there are still some drawbacks often related to the subcutaneous knot. As an alternative to open surgery we propose an original one-access technique with intraperitoneal knot.

Patients and methods: Between January 2009 and December 2019 we operated laparoscopically for inguinal hernia 61 non-consecutive patients (22F - 39M; aged 2 months - 17.5 years) selected for having associated contralateral or umbilical hernia, occasional diagnosis during one-trocar laparoscopy, presence of a ventriculo-peritoneal shunt or recurrence after open or laparoscopic repair. Every patient was treated with one-trocar trans-umbilical intraperitoneal closure of the inguinal ring using an operative laparoscope. Postoperative follow-up was 12 months.

Results: One-hundred-and-one hernias have been repaired (94 indirect - 6 direct; 24 unilateral - 38 bilateral, 1 also with a femoral defect). No surgical complications occurred and no additional access nor conversion were required. Follow-up was uneventful and postoperatively there were no skin tags but the navel. In the first half of patients we had 5 recurrences that were resolved with the same technique, alike 6 failures of open surgery, while in the following cases we observed a decrease of operative time and no recurrence.

Conclusions: One-trocar trans-umbilical laparoscopic inguinal hernia repair with intraperitoneal knot is safe and effective. This method is scarless and prevents any complication or cosmetic blemish due to subcutaneous stitch.