@article{10.11648/j.ijcu.20200402.19,
  author = {William Kagetsu Bukowski and Timothy Paul Bukowski},
  title = {Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures},
  journal = {International Journal of Clinical Urology},
  volume = {4},
  number = {2},
  pages = {73-76},
  doi = {10.11648/j.ijcu.20200402.19},
  url = {https://doi.org/10.11648/j.ijcu.20200402.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20200402.19},
  abstract = {Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.},
 year = {2020}
}

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TY  - JOUR
T1  - Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures
AU  - William Kagetsu Bukowski
AU  - Timothy Paul Bukowski
Y1  - 2020/10/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijcu.20200402.19
DO  - 10.11648/j.ijcu.20200402.19
T2  - International Journal of Clinical Urology
JF  - International Journal of Clinical Urology
JO  - International Journal of Clinical Urology
SP  - 73
EP  - 76
PB  - Science Publishing Group
SN  - 2640-1355
UR  - https://doi.org/10.11648/j.ijcu.20200402.19
AB  - Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.
VL  - 4
IS  - 2
ER  - 

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