Novel application of the sewing machine principle; a new simplified intracorporeal suturing technique for pediatric inguinal hernia

Space: StayCurrentMD Author: Rafik Shalaby, Mohamad Abdalrazek, Ashraf Hamed, Sayed Elhady, Refaat Ibrahim, Mohamad Shahin, Ahmad Helal, Adham Elsaied, Soliman Mohamad, Mohamad Mahfouz, Mohamad Elsherbeny, Mo',men El-Lithy Published: 2019-03-01

Author / Expert

Rafik Shalaby, Mohamad Abdalrazek, Ashraf Hamed, Sayed Elhady, Refaat Ibrahim, Mohamad Shahin, Ahmad Helal, Adham Elsaied, Soliman Mohamad, Mohamad Mahfouz, Mohamad Elsherbeny, Mo',men El-Lithy

Topic overview

Abstract

Background

The desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine.

Methods

The first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate.

Results

The sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ± 1.2 months.

Conclusion

The closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.