Percutaneous Endoscopically Assisted Repair (PEAR) of Inguinal Hernia

from the APSA 2015 Annual Meeting proceedings

FROM BENCHTOP TO BEDSIDE: EVOLUTION OF THE MODERN LAPAROSCOPIC PEDIATRIC INGUINAL HERNIA REPAIR

Author:

Nicholas E. Bruns, MD, Todd A. Ponsky, MD.
Akron Children’s Hospital, Akron, OH, USA.

Purpose:
Laparoscopic pediatric inguinal hernia repair is an evolving procedure. We have previously shown certain maneuvers in the laparoscopic high ligation improve efficacy in the animal model. The purpose of this video presentation is to define a laparoscopic technique in children that provides equivalent efficacy of the open repair and to implement elements of the technique that were learned from an animal model.

Methods:
Based on animal research, braided suture and peritoneal injury have been suggested to improve durability of repair in the animal model likely by stimulating inflammation and scar tissue. We have thus modified Patkowskiâs method of percutaneous internal ring suturing to include the use of braided suture and peritoneal thermal injury.

Results:
This technique anecdotally has shown to be durable and effective.

Conclusions:
This technique is safe and efficacious for indirect inguinal hernia repair in children and may show promise in adults. Further study is needed to determine long term outcomes.

Procedure Indications Contraindications Setup Preoperative Workup Anatomy And Landmarks Advantages/Disadvantages Complications/Risks Disclosure of Conflicts Acknowledgements References