Laparoscopic assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children

Abstract

BACKGROUND/PURPOSE: We describe our modifications of laparoscopic assisted simple suturing obliteration (LASSO) using an epidural needle with preperitoneal hydrodissection, which confer greater ease, safety, speed, and success to this procedure. METHODS: Under laparoscopic visualization through a single umbilical port, an 18-gauge epidural needle was inserted at the point of the internal ring. The orifice of the hernia defect was obliterated extraperitoneally by a non-absorbable suture that was introduced and withdrawn through the epidural needle around the internal ring using the hydrodissection-lasso technique. RESULTS: A total of 251 inguinal repairs were performed by LASSO in 207 children.163 patients had unilateral inguinal hernia repairs and 44 patients underwent repair of bilateral inguinal hernias. Mean operating time for unilateral and bilateral inguinal hernia repairs were 18.1 A±5.4 min and 26.6 A± 4.8 min, respectively. There were no intra-operative complications and no recurrences at mean follow-up of 17 months. No other complications (wound infection, suture granuloma formation, hydrocele) were found postoperatively. CONCLUSIONS: LASSO using an epidural needle with preperitoneal hydrodissection as a handy technique has proved to be a safe and effective in the treatment of inguinal hernia in children. It is easy to perform and therefore is a worthy choice for PIH.