Single-port laparoscopic herniorrhaphy using reverse puncture technique without hydrodissection in treatment of pediatric inguinal hernia

Abstract Background In single-port laparoscopic percutaneous extraperitoneal closure, hydrodissection is commonly used. Although hydrodissection makes the operation easier, it can cause shock and twist the vas deferens. The aim of this study was to investigate whether the reverse puncture technique could be used instead of hydrodissection.Methods Between March 2019 and January 2021, 132 children with inguinal hernias underwent single-port laparoscopic percutaneous extraperitoneal closure using the reverse puncture technique. The double-hook core needle with a suture was used to puncture the abdominal cavity along the lateral border of the internal ring under single-port laparoscopic vision. The suture was left in the abdominal cavity. The needle was then passed through the gap between the vas deferens / spermatic vessels and the peritoneum along the medial border of the internal ring to capture the end of the suture. The suture was tied in the extraperitoneal space after it was brought out of the abdominal wall.Results The 132 patients, 106 males and 26 females, had an average age of 2.71 ± 2.18 years. Sixty patients were chosen for bilateral surgery, with 57 of them having contralateral patent processus vaginalis. The average operating time for unilateral and bilateral cases was 9.9 ± 2.1 and 15.4 ± 3.3 minutes, respectively. One patient had a recurrence during the 9 to 24 month follow-up period (0.7%).Conclusions For the treatment of pediatric inguinal hernias, single-port laparoscopic percutaneous extraperitoneal closure utilizing the reverse puncture technique provides a simpler and safer option.