Laparoscopic Hernia Repair and Its Validation by Second-Look Inspection to Internal Inguinal Rings in Children with Patent Processus Vaginalis

We developed a unique technique for achieving the completely extraperitoneal ligation of a patent processus vaginalis (PPV) without skipping any areas (Endo et al., 2001). This technique has been used for the treatment of more than 1,600 children. A previous comparative study of this technique with the traditional cut-down repair method proved the superiority of this technique with respect to the parental perspective and choice, operative time, recurrence rate, metachronous appearance of contralateral hernia, complication of the reproductive system, and cosmetic results (Endo et al., 2009). However, some concerns have been voiced regarding the use of laparoscopic herniorrhaphy in children such as the use of a simple closure without the division of the hernial sac, evidence of a completely closed internal inguinal ring (IIR), validity with regard to future recurrence, and the high risk of adhesion (Miltenburg et al., 1998, Gorsler et al., 2003, Saranga et al., 2008). Since 1996, when we began to close PPV laparoscopically, we have conducted prospective studies involving laparoscopic inspection at previous operation sites at every opportunity so as to validate the efficacy of this procedure. The purpose of this paper was to introduce our procedure and the use of recently devised, innovative “Endoneedle kit”, comparing the outcome, including the morphological appearance of the IIRs in second-look operations, with the outcome of traditional cut-down herniorrhaphy performed during the same period.