Needlescopic inversion and snaring for inguinal hernia repair in girls using 1.6-mm instruments

• Published in: Journal of pediatric endoscopic surgery Vol. 3; no. 3; pp. 167 - 173
• Main Authors: Shalaby, Rafik, Elsawaf, Mohamed, Mohamad, Yousef, Daboos, Mohamad, Othman, Al-Sayed, Abdelhafez, Muhammad, Ibrahim, Refaat, Negm, Mohamed Ahmed
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.09.2021
• Subjects: Abdominal Surgery; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Pediatric Surgery; Surgery; Technical Advances; Thoracic Surgery; Suture grasper device; Inversion; Needlescopy; Pediatric hernia repair; Fallopian tube injury
• ISSN: 2524-7875; 2524-7883
• DOI: 10.1007/s42804-021-00104-x

Background Two millimetere needlescopic instruments induce minimal trauma to the abdominal wall and have excellent cosmetic results. However, these instruments are fragile and expensive with short weak jaws. The aim of this study was to present a novel needlescopic approach for inguinal hernia (IH) repair in girls using 1.6-mm suture grasper device (SGD), modified polypectomy snare (MPS) and a home-made snare (HMS). We refer to this technique as needlescopic inversion and snaring of hernial sac in girls. Patients and methods Over a period of 1 year from March 2018 to March 2019, a prospective study was conducted on girls that presented with IH. Preoperative inguinal ultrasound was performed in all patients to measure the internal inguinal ring (IIR) diameter. All hernias were repaired by our novel technique using two SGDs, MPS or HMS. Follow-up period was at least 12 months. Results Fifty-three girls with 74 hernias were included in this study, with a mean age of 38 ± 8 months. IIR diameter ranged between 8 and 15 mm with a mean of 11 ± 2 mm. Mean operative time was 15 ± 3 min in bilateral and 11 ± 2 min in unilateral presentations. All procedures were completed successfully with no conversion and without major complications. Follow-up ranged from 12 to 24 (median 16.5) months. Non-visible scars were obtained in all cases and there was no reported recurrence. Conclusion Needlescopic inversion and snaring of inguinal hernial sac in girls using 1.6-mm instruments, MPS or a HMS is a safe, rapid and feasible method for IH repair. It has the advantage of invisible scars and no recurrence in the short-term outcomes.