Needlescopic sutureless repair of congenital inguinal hernia: A randomized controlled study

Abstract

Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and stitching peritoneal defects. Other studies claimed that peritoneal disconnection alone is sufficient. In this study, the feasibility, operative time, recurrence rate, and other postoperative complications of needlescopic disconnection of the CIH sac with or without peritoneal defect suturing were compared. A prospective controlled randomized trial was conducted between January 2020 and December 2022. Two hundred and thirty patients who met the study requirements were included. Patients were assigned at random to either Group A or Group B. A group of 116 patients (Group A) had needlescopic separation of the neck of the sac and peritoneal defect closure. The remaining 114 patients (Group B) underwent needlescopic separation without peritoneal defect closure (Sutureless group). A total of 260 hernial defects in 230 patients were repaired using needlescopic disconnection with or without suturing of the defect. There were 89 females (38.7%) and 141 males (61.3%), with a mean age of 5.14 ± 2.79 years. In Group A, the mean operation time was 27.98 ± 2.89 for a unilateral hernia and 37.29 ± 4.68 for a bilateral one, whereas, in Group B, the mean operation time was 20.37 ± 2.37 and 23.38 ± 2.22 for a unilateral and bilateral hernia, respectively. In terms of the operating time, whether unilateral or bilateral, there was a significant difference between the groups. There was no significant difference between groups A and B in the mean Internal Ring Diameter [IRD], which was 1.21 ± 0.18 cm in group A and 1.19 ± 0.11 cm in group B. Throughout the follow-up period, there was no postoperative hydrocele formation, recurrence, iatrogenic ascending of the testes, or testicular atrophy. All patients had nearly invisible scars with no keloid development at 3 months follow-up. Needlescopically separating the hernia sac without stitching the peritoneal defect is feasible, safe, and less invasive. It provides outstanding cosmetic results with a short operative time and no recurrence.

Keywords: Diathermy probe; Epidural needle; Infant and children; Mediflex; Needlescopic; Separation.

Fig. 1

Sites of camera port and needles for (1) left-sided CIH and (2) right-sided CIH. [1-A, Camera port. 1-B, site of insertion of DP. 1-LC, site of insertion of SGD. 2-A, Camera port, 2-B, site of insertion of SGD. 2-C, site of insertion of DP]

Fig. 2

Laparoscopic view of the right CIH in a male child. A, A piece of polypropylene suture was grasped between two SGDs to measure the widest diameter of the IIR. B, the suture was then taken outside, and the length was measured using a regular ruler graded by mm

Fig. 3

Steps of separating the hernia sac for left-sided CIH in a male child. A The vas and testicular vessels were swept off by blunt dissection using DP. B Complete hernial sac separation. V  vas deferance, TV testicular vessels, IIR internal inguinal ring, black asterisk SGD, white arrow  DP

Fig. 4

Steps of closing the peritoneal defect at IIR for left-sided CIH in a male child. A EN threading the Peirce string suture. B photo was taken after ligation of the suture and cutting both ends outside the abdomen. P peritoneum, Black asterisk SGD, white arrow EN