Between November 2017 and March 2018, 27 children
with inguinal hernias undertook laparoscopic percutaneous completely extraperitoneal closure in Department
of Surgery, Children's Hospital Capital Institute of Pediatrics and Department of Pediatric Surgery, the Second
Hospital of Hebei Medical University. Under single-port laparoscopic vision, an inner grappler with a non
absorbable suture was inserted at abdominal transverse striation to extraperitoneal space and was readily kept in an
identical subcutaneous path. The inclined surface of an inner grappler with suture reached back retroperitoneum
and passed through vas deferens without using hydrodissection technique. The same technique was utilized to
pass through spermatic vessel on outside of hernia, followed by ligation and close the orifice of inner hernia in
extraperitoneal internal ring closure using an inner grappler without puncture of peritoneum. Anthropological data
including basic data of patients and perioperative data were reviewed. All patients were followed up ranging
from 13 to 17 months after operation, and postoperative recurrence and complications were analyzed.
Results Age of all patients ranged from 11 months to 21 months, and 25 males and 2 females were involved
in the study. A total of 38 sides of orifices (16 cases of lateral hernia and 11 cases of bilateral hernia) were
successfully conducted single-port laparoscopic percutaneous completely extraperitoneal internal ring closure
using an inner grappler without hydrodissection. Mean operating time for unilateral and bilateral repairs
was (9.5±1.4) and (18.3±1.6) min. There were no wound infection, recurrence, iatrogenic cryptorchidism or
testicular atrophy, as well as granuloma with a 13 to 17 months of follow-up. Conclusion Single-port laparoscopic
percutaneous completely extraperitoneal internal ring closure using an inner grappler without hydrodissection is
safe and feasible for pediatric huge inguinal hernia.
2020, Vol. 8 
