Laparoscopic Circular Closure Through Muscle Layer to Subcutaneous Layer of Abdominal Wall Around the Hernia Ring in 9 Children With Occult Direct Inguinal Hernia
10.3969/j.issn.1009-6604.2025.03.009
- VernacularTitle:腹腔镜下经腹壁肌层至皮下环形缝扎疝环治疗儿童隐性腹股沟直疝9例
- Author:
Xuelai LIU
1
;
Jianji XU
1
;
Shiying FAN
1
Author Information
1. 首都儿科研究所附属儿童医院普通外科,北京 100020
- Publication Type:Journal Article
- Keywords:
Laparoscopy;
Direct inguinal hernia;
Hernia ring;
Closure;
Children
- From:
Chinese Journal of Minimally Invasive Surgery
2025;25(3):175-179
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the safety and feasibility of two-port laparoscopic full layer circular closure of the hernia ring for direct inguinal hernia.Methods Between September 2019 and February 2024,9 cases of pediatric indirect inguinal hernia were found to be accompanied by an occult direct inguinal hernia on the right side during two-port laparoscopic inner ring closure.After completing the high ligation of the indirect hernia under laparoscopic monitoring,the bottom of the direct hernia sac was investigated.The needle was held and inserted sequentially from the 4 o'clock direction,crossing the abdominal wall muscle layer through the peritoneum to the subcutaneous layer,and exited at the 8 o'clock direction.The same method was conducted from the 8 o'clock direction in and at the 12 o'clock direction out,and afterwards from the 12 o'clock direction in and at the 16 o'clock direction out(near the previous 4 o'clock insertion point),followed by knotting and closure of the hernia ring.Results Postoperative diagnosis indicated 3 cases of Pantalon hernia(right indirect hernia+right direct hernia)and 6 cases of left indirect hernia+right direct hernia.No extraperitoneal lipoma was found outside the hernia sac.Two-port laparoscopic high ligation of the indirect hernia and laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring was carried out.The operation time was(32.5±3.5)min,and blood loss was less than 1 ml.No intraoperative complications were seen.All the patients were discharged within 6 h after surgery and followed up for 5-13 months(mean,8 months),with 3 cases followed up for more than 12 months.No complications such as incision infection,recurrent hernia,hydrocele,iatrogenic cryptorchidism or testicular atrophy was found.Ultrasound examination of the direct hernia triangular area showed uniform thickness of the abdominal wall and no localized defects observed.Conclusions Laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring is safe and feasible.This procedure supplements the pediatric direct inguinal hernia repair procedure by suturing and closing both peritoneum and abdominal wall muscle layer of direct hernia defect without changing the normal anatomical position of the umbilical fold.
