WOFAPS 2025 8th World Congress of Pediatric Surgery

Fangfang Chen, Xiao You, Bo Hao

The First Affiliated Hospital of Bengbu Medical University

Objective:To evaluate the feasibility and clinical value of the ski-needle guided extraperitoneal suture delivery technique in preserving peritoneal integrity during single-incision laparoscopic herniorrhaphy for pediatric inguinal hernia, and to preliminarily assess its minimally invasive advantages over conventional intraperitoneal suture techniques.

Methods:

From January 2024 to December 2024, 60 children (aged 1-13 years) with unilateral inguinal hernia were prospectively enrolled and randomly allocated to:Study group (n=30): Single-incision laparoscopic extraperitoneal suture delivery using a ski-needle (optimized extraperitoneal space establishment with preserved peritoneal integrity)；Control group (n=30): Conventional intraperitoneal suture delivery (requiring peritoneal penetration). Outcome measures:① Primary endpoint: Peritoneal integrity② Operative metrics: Success rate, operative time, hospital stay③ Postoperative recovery: FLACC pain scores (at 12/24h), complications (wound infection, hydrocele of spermatic cord, testicular atrophy)④ Long-term endpoint: Recurrence rate (follow-up ≥6 months).

Results:
Preliminary analysis demonstrated:Both groups achieved 100% surgical success.Peritoneal integrity: 96.7% vs. 0% (P<0.001)；Hospital stay: 46.0 ± 2.0 vs. 45.0 ± 3.0 hours (P=0.101)；Operative time: 31.0 ± 5.0 vs. 30.2 ± 4.1 minutes (P=0.475)；FLACC scores at 12h: 1.9 ± 0.6 vs. 2.4 ± 0.8 (P=0.006)；Wound infection: 0% vs. 3.3% (P=1.000)；No testicular atrophy occurred in either group；Zero recurrence at 6-month follow-up.

Conclusion:
The ski-needle guided extraperitoneal suture technique is safe and effective. It elevates surgical objectives from "defect repair" to "anatomic preservation," establishing a new paradigm for transitioning pediatric inguinal hernia surgery from minimally invasive to ultra-minimally invasive approaches.