Purpose or Case Report: There are a number of techniques used to repair inguinal hernias, both open a laparoscopic. Here we report a case series of a novel method, inguinal herniorrhaphy using ultrasound guidance.
Methods & Materials: With IRB approval, all cases of ultrasound guided inguinal hernia repair at our institution from November 2017-June 2019 were retrospectively reviewed. Data collected included demographics, operative time and complications. All patients were females. The steps of the procedure are as follows: A meniscus repair needle (Smith&Nephew) was passed with ultrasound guidance (L20-5 Linear transducer Zonare), suture was passed, percutaneously around the hernia sac in order to ligate it. A needle laparoscope was placed to confirm appropriate ligation of the hernia.
Results: 27 patients underwent for a total of 34 hernia repairs (6 bilaterals). Median age was 4.7years (IQR 2.6-6.6) and median weight was 16.0kg (IQR 12.8-21.3). Mean operative time was 42min (IQR 31-45). There were 6 patients (6/27) who had undiagnosed contralateral hernias that were identified at the time of surgery with ultrasound. There were 7 conversion to laparoscopy (21%), 4 for sliding hernias, one for Canal of Nuck cyst and 2 ligation failures (6%). There were 2 post-operative fluid collections but neither required intervention. There was on reoperation for a suture granuloma. There were no recurrences.
Conclusions: Initial experience in inguinal herniorrhaphy using ultrasound guidance in females is safe and effective. In the future this technique could be performed without laparoscopic confirmation and under sedation to avoid general anesthesia.