Novel modification of laparoscope-assisted inguinal hernia ligation to decrease knotting associated complications

Currently, laparoscopic percutaneous extraperitoneal ligation (LPEL) is popular both with patients and surgeons due to the simplified surgical procedure and cosmetic results [1]. However, adverse events associated with extraperitoneal knotting, such as infection, pain, and a palpable thread knot around the inguinal area of the abdominal wall might occur in the LPEL procedure [2,3]. Incorporating extra abdominal wall tissue into the knot as a consequence of the different puncture routes is the main cause.