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Helal Helal simplified technique

procedures for inguinal hernia repair. 2. Cam C, Celik C, Sancak A, Iskender C, Karateke A. Inguinal
herniorrhaphy in childhood may result in tubal damage and future
One of the major limitations of SILHR is that the infertility. Arch Gynecol Obstet 2009;279:175-6.
instruments lie almost parallel to each other without 3. Chinnaswamy P, Malladi V, Jani KV, Parthasarthi R, Shetty RA,
Kavalakat AJ, Prakash A. Laparoscopic inguinal hernia repair in
triangulation (unlike conventional laparoscopic children. JSLS 2005;9:393-8.
surgery). [16] In our new technique, the percutaneous 4. Chow A, Purkayastha S, Paraskeva P. Appendicectomy and
insertion of a complete purse string suture using EN is cholecystectomy using single-incision laparoscopic surgery (SILS):
a straightforward procedure for female children (no vas the first UK experience. Surg Innov 2009;16:211-7.
or vessels need to be protected) with easy retrieval of 5. de Armas IA, Garcia I, Pimpalwar A. Laparoscopic single port
thread from the EN. Moreover, withdrawal of the thread surgery in children using Triport: our early experience. Pediatr Surg
from the same facial opening of the needle holder entry Int 2011;27:985-9.
acts as a guide for reinsertion of the needle holder and 6. Dorsey JH, Sharp HT, Chovan JD, Holtz PM. Laparoscopic knot
strength: a comparison with conventional knots. Obstet Gynecol
avoids trial and error during blind re-entry. Furthermore, 1995;86:536-40.
the use of a laparoscopic needle holder allows us to 7. Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E.
stretch the peritoneum in front of the EN and thus avoid Laparoscopic completely extraperitoneal repair of inguinal hernia in
the presence of any skip areas. The use of a self-sliding children: a single-institute experience with 1,257 repairs compared
clinch knot avoids the need for a tie pusher, unlike with cut-down herniorrhaphy. Surg Endosc 2009;23:1706-12.
many other extracorporeal knots. [16] One well-known 8. George EK, Oudesluys-Murphy AM, Madern GC, Cleyndert P,
disadvantage of laparoscopic knot tying is the reduced Blomjous JG. Inguinal hernia containing the uterus, fallopian tube and
sensation of the tension applied to the tissues and the 9. ovary in premature female infants. J Paediatr 2000;136:696-8.
Harrison MR, Lee H, Albanese CT, Farmer DL. Subcutaneous
knot. Tightening of the knot in our technique, using a self- endoscopically assisted ligation (SEAL) of the internal ring for repair
sliding extracorporeal clinch knot, and its reinforcement of inguinal hernias in children: a novel technique. J Pediatr Surg
with a laparoscopic single instrument tie, preserves 2005;40:1177-80.
tactile sensation and allows for accurate adjustment of 10. Ladd WE, Gross RE. Abdominal surgery of infancy and childhood.
the tension applied to the tissues, thus ensuring the firm Philadelphia, PA: WB Saunders; 1941.
and secure closure of the IIR. [11,12,16,19,20,30,31] 11. Lee Y, Liang J. Experience with 450 cases of micro laparoscopic
herniotomy in infants and children. Pediatr Endosurg Innov Tech
In conclusion, this simplified technique is feasible, 2002;6:25-8.
only requires a short operative time, does not lead to 12. Helal AA. Laparoscopic single instrument closure of inguinal hernia
in female children: a novel technique. J Pediatr Surg 2015;50;1613-6.
recurrence, and yields better cosmetic outcomes in 13. Ismail M, Shalaby R. Single instrument intracorporeal knot tying
female children. In addition, this technique extends the during single port laparoscopic hernia repair in children: a new
benefits of single-incision endosurgery and avoids the simplified technique. J Pediatr Surg 2014;49:1044-8.
drawbacks of extracorporeal knotting. 14. Lukong CS. Surgical techniques of laparoscopic inguinal hernia repair
in childhood: a critical appraisal. J Surg Tech Case Re 2012;4:1-5.
Author’s contributions 15. McClain L, Streck C, Leshar A, Cina R, Hebra A. Laparoscopic
A.A. Helal contributed solely to this paper. needle-assisted inguinal hernia repair in 495 children. Surg Endosc
2015;29;781-6.
16. Weston PV. A new clinch knot. Obstet Gynecol 1991;78:144-7.
Financial support and sponsorship 17. Schier F. Laparoscopic herniorrhaphy in girls. J Pediatr Surg
None. 1998;33:1495-7.
18. Schier F. Laparoscopic inguinal hernia repair-a prospective personal
series of 542 children. J Pediatr Surg 2006;41:1081-4.
Conflicts of interest 19. Takehara H, Yakabe S, Kameoka K. Laparoscopic percutaneous
We have no conflicts of interest and no financial extraperitoneal closure for inguinal hernia in children: clinical
disclosures. outcome of 972 repairs done in 3 pediatric surgical institutions. J
Pediatr Surg 2006;41:1999-2003.
Patient consent 20. Becmeur F, Philippe P, Lemandat-Schultz A, Moog R, Grandadam
S, Lieber A, Toledano D. A continuous series of 96 laparoscopic
Written informed consent was obtained from parents. inguinal hernia repairs in children by a new technique. Surg Endosc
2004;18:1738-41.
Ethics approval 21. Giseke S, Glass M, Tapadar P, Matthyssens L, Philippe P. A true
The study protocol was approved by the ethical laparoscopic herniotomy in children: evaluation of long-term
outcome. J Laparoendosc Adva Surg Tech A 2010;20:191-4.
committee of our hospital. 22. Lee DY, Baik YH, Kwak BS, Oh MG, Choi WY. A purse-string
suture at the level of internal inguinal ring, taking only the peritoneum
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1. Babsail AA, Abelson JS, Liska D, Muensterer OJ. Single-incision 23. Muensterer OJ, Georgeson KE. Multimedia manuscript: inguinal
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