Modifications of surgical techniques in laparoscopic percutaneous extraperitoneal closure of inguinal ring for childhood inguinal hernia to achieve zero recurrence and zero subcutaneous stitch granuloma
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In brief
In brief
This study reports technical modifications to single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for pediatric inguinal hernia that eliminated both recurrence and subcutaneous stitch granuloma in 1,755 patients. Key modifications include nonabsorbable sutures, peritoneal thermal injury, and selective double ligation of the internal inguinal ring.
- Nonabsorbable monofilament suture with peritoneal thermal injury at IIR eliminates recurrence in laparoscopic pediatric hernia repair.
- Cannula-guided suturing ensures peritoneum-only ligation, avoiding muscle/fascia inclusion that causes granulomas.
- Modified SILPEC technique achieved 0% recurrence and 0% subcutaneous stitch granuloma in 1755 patients over 40-month follow-up.
- Double ligation of IIR in selected cases contributes to zero recurrence rate without testicular complications.
- Technical refinements reduced recurrence from 2.3% to 0% and granuloma formation from 1.5% to 0% compared to standard technique.
Written by the GCMD Library team from the article.
Abstract
Purpose
To present our technical modifications of single incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of the internal inguinal ring (IIR) for pediatric inguinal hernia (PIH).
Methods
The prospectively collected data of all children diagnosed with PIH undergoing SILPEC at our center from 2016 to 2023 were reviewed and divided into two groups for result comparison: Group A: before and Group B: after the implementation of full modifications. Our modifications included using a nonabsorbable monofilament suture, creating a peritoneal thermal injury at the internal inguinal ring (IIR), employing a cannula to ensure the suture at the IIR ligates only the peritoneum, and double ligation of the IIR in selected cases.
Results
1755 patients in group A and in group B (1 month to 14 years old) were enrolled. There were no significant differences regarding baseline patient characteristics between the two groups. At a median follow-up of 40 months, the rate of recurrent CIH and subcutaneous stitch granuloma (SSG) was 2.3% and 1.5% in group A vs. 0% and 0% in group B (p < 0.001). There were no hydroceles, no ascended or atrophic testis.
Conclusions
Our SILPEC technical modifications can achieve zero recurrence and zero SSG for PIH.