Stitch versus scar-evaluation of laparoscopic pediatric inguinal hernia repair: A pilot study in a rabbit model

Background: Many have questioned whether the laparoscopic, percutaneous hernia repair technique is as durable as an open repair in which the sac is divided and ligated. We set out to assess if the suture alone causes enough injury and scar over time to obliterate the internal ring. Materials and Methods: In total, 28 male rabbits with congenital patent processus vaginalis underwent laparoscopic repair with the subcutaneous endoscopically assisted ligation technique. For Group 1 the repairs were evaluated laparoscopically at predetermined time points before and after removal of the ligating suture. Group 2 assessed the effect of sharp peritoneal trauma at the time of repair and was evaluated at 2 and 4 weeks. Results: When durability of repair with suture alone was evaluated, all repairs failed after insufflation to 35 mm Hg after suture removal out to a time point of 12 weeks. In the peritoneal trauma group, at the 2-and 4-week survival time point, 87.5% and 100%, respectively, of repairs remained intact after removal of suture. In contrast, only 25% and 12.5%, respectively, of defects remained closed in the animals repaired with suture ligation alone. Conclusions: The laparoscopic, percutaneous hernia repair may rely heavily on the suture itself to prevent recurrence. In the event of suture failure, this could lead to an increasingly high recurrence rate. The addition of minor peritoneum trauma may induce sufficient scarring to provide a more durable repair.