Laparoscopic herniorrhaphy in girls

Background/Purpose: Laparoscopy has been used to evaluate the contralateral side in inguinal hernias. Once a hernia was identified in such procedures, laparoscopy was terminated and a conventional groin exploration was undertaken. This study presents a purely laparoscopic approach using miniature instruments without the use of a groin incision. Methods: The technique was applied in 14 girls (median age, 6.5 years). The laparoscope was inserted via the umbilicus. Two 1.7- or 2-mm instruments were advanced (without a trocar) trough the abdominal wall for intraabdominal suturing of the open inguinal rings by the placement of two to three Z-sutures. Results: With this procedure the diagnosis is easy, although the placing of miniature suturing needs practice. When there is doubt about an inguinal ring during laparoscopy, an open processus vaginalis also can be sutured using the same approach. There were no recurrences or complications. The longest follow-up period is 1 year. Conclusions: A purely laparoscopic approach using miniature instruments combines diagnosis and immediate treatment without the need for conversion to another technique. There is rapid recovery and excellent cosmetic results. Copyright (C) 1998 by W.B. Saunders Company.