Customized Management of Female Indirect Inguinal Hernias Using Single-Port Laparoscopic PIRS

Overview

This study compares the use of single-port laparoscopic percutaneous internal ring suture (SPIRS) for repairing female indirect inguinal hernias (IIHs) in pediatric versus adult populations. The technique demonstrated effective closure of the internal ring opening with favorable postoperative outcomes in both groups.

Background

Indirect inguinal hernias (IIHs) are the predominant type of inguinal hernias in pediatric females, with laparoscopic PIRS established as a safe and effective repair method. In adults, the etiology of IIHs is less clear but may involve persistent processus vaginalis. Female inguinal hernia repairs have higher reoperation rates, and standard male repair techniques may not be optimal for females. This study aims to tailor repair strategies based on laparoscopic classification of hernia subtype in females across age groups.

Data Highlights

Key Findings

• SPIRS effectively closes the internal ring opening at the preperitoneal level using a nonabsorbable suture under laparoscopic guidance.
• The procedure is customized by age group, using different needle sizes and intra-abdominal pressures for pediatric versus adult patients.
• Contralateral processus vaginalis can be identified and sealed during the same procedure to prevent future hernias.
• Postoperative pain management with NSAIDs was standardized and well tolerated in both groups.
• Outcomes assessed included wound pain, activity resumption, cosmetic satisfaction, and recurrence, with favorable results reported.

Clinical Implications

SPIRS offers a minimally invasive, tailored approach for female IIH repair that can be safely applied across pediatric and adult populations. The technique allows for precise closure of the internal ring and simultaneous treatment of contralateral defects, potentially reducing recurrence rates. Surgeons should consider patient age and anatomy when selecting needle size and intra-abdominal pressure settings to optimize outcomes.

Conclusion

Single-port laparoscopic PIRS is a safe and effective method for repairing female indirect inguinal hernias in both children and adults, with customized procedural adaptations enhancing surgical success and patient recovery.

References

1. Patkowski et al. -- Introduction of laparoscopic PIRS technique
2. Swedish Hernia Register -- Female inguinal hernia repair outcomes
3. Chang Gung Memorial Hospital Ethical Review Board -- Study approval