Trans-umbilical two-port laparoscopic suturing of the inguinal hernia defect with percutaneous assistance: a safe and efficient scarless surgery for pediatric inguinal hernia repair.
PURPOSE
This study was aimed to describe the technique of the modified trans-umbilical two-port laparoscopic suturing (M-TTLS), and show its feasibility and efficacy to treat pediatric inguinal hernia (PIH).


METHODS
After general anesthesia, the patient was placed in the Trendelenburg position. Two trocars were set on umbilicus and a pneumoperitoneum was established at 8-12 mmHg. Under direct vision, a long syringe needle was punctured into the preperitoneal space above the internal inguinal ring (IIR). After the peritoneum separated by hydrodissection, the syringe needle was left in peritoneal cavity. A suture needle with 2-0 silk suture was periced into abdomen, and its tip was then inserted into the syringe needle hole by laparoscopic needle holder. Under the syringe's guidance, the peritoneum on the surface of the vessels and vas was sutured intactly by a single stitch. Subsequently, the rest peritoneum was sutured continuously in a clockwise direction. After a purse-string suture completed, the orifice of hernia sac was closed intracorporeally by a single-instrument tie technique.


RESULTS
Overall, 139 patients with PIH underwent M-TTLS, including 130 boys and 9 girls. Median age was 46.8 months. All procedures were performed uneventfully without conversion. Median operation time was 12 min for unilateral and 17 min for bilateral operations. There were three minor extraperitoneal hematomas occurred during the operation. After a median follow-up of 13 months, no common complications developed and no visible scars were observed on the abdominal wall.


CONCLUSIONS
M-TTLS is a safe and efficient scarless surgery for PIH repair.
['Shou|T|T|', 'Zhong|H|H|', 'Wang|F|F|http://orcid.org/0000-0002-4879-6752']
D000293:Adolescent D002648:Child D002675:Child, Preschool D002921:Cicatrix D005260:Female D006552:Hernia, Inguinal D059685:Herniorrhaphy D006801:Humans D007223:Infant D010535:Laparoscopy D008297:Male D013536:Suture Techniques D016896:Treatment Outcome D014472:Umbilicus
Laparoscopic Inguinal hernia Scarless surgery M-TTLS Children