Laparoscopic Inguinal Herniorraphy with an Extracorporea Suturing Needle

ABSTRACT

This report describes an innovative and effective application of the extracorporeal suturing needle (ESN) to perform a laparoscopic inguinal herniorraphy. Between 1/1/96 and 12/31/96, we treated 23 patients with inguinal hernia using this suturing needle uniquely designed by Nahm-gun Oh. This new technique and device allow sutures to be made in the tissues near the floor of the internal inguinal canal without exposing the area while the movement of the ESN is observed with a laparoscopic camera. In 16 patients, the internal inguinal ring was ligated and fixed medially to the fascial root of the inferior epigastric vessels and to laterally the internal oblique muscle, using the ESN. In 5 patients with large inguinal hernias, the sutures were placed to force the inguinal canal with intraperitoneal onlay mesh fixation to the fascia, using the ESN, causing a narrowing of the internal inguinal canal. In 2 patients with inguinal hernias, the peritoneum of the internal inguinal ring was closed and laterally fixed to the internal oblique muscle by using the ESN. The ESN has been used successfully in 96% of the patients with inguinal hernias. One patient had a recurrence of the hernia. No permanent complications were seen in the patients involved in this study. Some transient postoperative complications included groin pain (21%), urinary retention (13%), and abdominal wall hematoma (9%). In four patients (17%), contralateral inguinal hernias were discovered during their operations and were corrected using the same procedures. We conclude that the extracorporeal suturing needle was safely and effectively used in laparoscopic inguinal herniorrhaphies and should be considered for use in laparoscopic herniorrhaphies and other laparoscopic surgeries.