ABSTRACT
Objective To investigate the safety and feasibility of two-port laparoscopic inner ring closure assisted by extracorporeal suture traction for indirect inguinal hernia with folded peritoneum around inner orifice in children.Methods Between October 2019 and February 2023,a total of 322 children with indirect inguinal hernia underwent two-port laparoscopic inner ring closure,in which 186 cases(292 sides)with folded peritoneum around inner ring orifice were given assistance by extracorporeal suture traction.Under laparoscopic vision in the umbilicus,a needle with a non-absorbable suture was inserted into the abdominal cavity through the outer lower edge of the inner ring,followed by inserted from the extraperitoneal space to the outer edge of the spermatic cord blood vessel.The needle was again inserted at the outer edge of the spermatic cord blood vessel,and the suture tail was gently pulled outside the body.Under direct laparoscopy,the retroperitoneal space near the insertion point was enlarged.Afterwards the suture was crossed the surface of the spermatic cord blood vessel in the retroperitoneal space.In the same way the extracorporeal suture traction was engaged to expand folded peritoneum and enlarge extraperitoneal space for convenience of needle passing through the Doom's triangle,as well as the vas deferens.The inner wall and upper wall peritoneal tissue of the inner ring were continuously sutured under direct visualization.The needle was removed and a knot was made at the initial insertion point,with the inner ring opening being closed.Results In 292 sides,after extracorporeal suture was used to stretch the folded peritoneum,the suture was able to smoothly cross the spermatic cord blood vessels,the Doom's triangle,and the surface of the vas deferens.The operating time for unilateral hernia was(18.5±3.2)min in80 cases and for bilateral hernia was(32.6±5.3)min in106 cases.No intraoperative complications were found and all the patients were discharged from hospital within 6 hours.A total of 122 cases were followed up for 3-18 months(mean,8.5 months)after surgery.No complications such as incision infection,iatrogenic cryptorchidism,or testicular atrophy were observed.There were no recurrent hernia or hydrocele.Conclusion For indirect hernia with folded peritoneum around inner ring orifice,extracorporeal suture traction effectively expands the folded peritoneum,and assists the needle with suture passing through the surface of spermatic cord blood vessels,the Doom's triangle,and the vas deferens in extraperitoneal space,and decreases the difficulty of surgery,presenting better safety and feasibility.