Percutaneous Internal Ring Suturing (PIRS) – The Benefits of Laparoscopic Inguinal Hernia Repair

Przemysław Karol Wolak,1,2 Agnieszka Strzelecka,1 Aneta Piotrowska - Gall,1,2 Piotr Przemysław Wolak,3 Ilona Piotrowska,4 Katarzyna Dąbrowska,5 Joanna Wróbel,1 Grażyna Nowak-Starz1 1Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland; 2Department of Pediatric Surgery, Urology and Traumatology, Regional Hospital in Kielce, Kielce, Poland; 3City Hospital of Zabrze, Zabrze, Poland; 4Regional Hospital in Kielce, Kielce, Poland; 5Department of Neonatology and Neonatal Intensive Care, Polish Mother’s Memorial Hospital Research Institute, Łódź, PolandCorrespondence: Przemysław Karol Wolak, Tel +48 501 525 549, Email przemyslaw.wolak@ujk.edu.plIntroduction: The laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.Purpose: The study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.Patients and Methods: We conducted a retrospective study that included children aged 0– 18 treated using the PIRS technique in 2008– 2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method.Results: The recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia.Conclusion: The laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.Keywords: inguinal hernia, PIRS, children, laparoscopy