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Subcutaneous endoscopically assisted ligation using miniport for the treatment of girls with inguinal hernia

Akinari Hinoki
Ikeda Rie
Daiki Kitagawa
Kazuki Koiwai
Takemaru Tanimizu
Kazuo Hase
Shigeki Takahashi


Background This report describes the first miniport method using  subcutaneous endoscopically assisted ligation (SEAL) for the treatment of girls with inguinal hernia. To validate its safety and efficacy, the  authors evaluated their early experiences.

Methods Between April 2014 and December 2014, 19 SEALs using miniport were performed on 14 patients at the Fukaya Red-Cross Hospital, Saitama, Japan. Their mean age was 6 years (range, 11–128 months). This technique was performed using two ports (a 5mm port placed using the open technique and an additional 2mm miniport). A 5mm laparoscope was inserted via the umbilicus. The miniport was introduced percutaneously in the inguinal region under laparoscopic guidance and manipulated around the medial or lateral   hemicircumference of the internal ring extraperitoneally to place a purse-string around the internal ring. The hernia sac and patent processus vaginalis were closed at the level of the internal inguinal ring   extraperitoneally with circuit suturing using the 2mm miniport. Only the umbilical fascia was closed with an absorbable suture. No skin sutures were applied. We collected data regarding operative time, complications,
and recurrence.

Results The mean operative time was 20 ±6 min (unilateral, n =9) or 42± 8 min (bilateral, n= 5). The mean follow-up period was 12.8 ± 2.5 (range, 9–19) months. No intraoperative complications associated with the
procedure occurred and no hernial recurrences have been identified so far.

Conclusion SEAL using miniport proved to be a successful operative procedure compared with other  laparoscopic percutaneous extraperitoneal closure procedures and produced excellent cosmetic results. SEAL using miniport for the treatment of girls with inguinal hernias appears to be safe, effective, and reliable.

Keywords: inguinal hernia, miniport, SEAL