Laparoscopic inversion and ligation inguinal hernia repair in girls

Inguinal hernia repair is one on the most frequently performed operative procedures in pediatric surgery. The technique of high ligation of the hernia sac has been described for over a century and has proven to be a highly effective and durable repair. Several laparoscopic repairs have been described but, at least in boys, all of them have a slightly higher recurrence rate. This may be due to the fact that they leave an intact sac that has been sutured closed. We describe a technique in girls in which the sac is grasped, inverted, and then ligated with an endoloop. This technique is simple and can be performed quickly. Using 3-mm instruments without trocars minimizes the length of the incisions and postoperative pain is almost nonexistent. Furthermore, with the addition of the leash technique, dissection of an adherent ovary can be done without damaging the sac. We have performed this procedure in over 30 patients and have had no recurrences. We believe that this could become the laparoscopic repair of choice in females with inguinal hernias.