Inguinal herniorrhaphy is the most commonly performed operation in the pediatric population. Traditionally, these operations are performed via a groin incision and a high ligation of the hernia sac. We present a video describing a laparoscopic approach which involves inguinal hernia inversion and ligation.

The operation is performed with only one trocar, placed at the umbilicus in order to allow for a 5 mm, 30 degree telescope. Two additional 3mm incisions are made in the flanks at the level of the umbilicus. The pelvis is first inspected carefully in order to delineate the anatomy and define the pathology. Using 3mm graspers, the hernia sac is inverted and the round ligament is bluntly freed from its attachments to the labia. The hernia sac is then ligated using 0-PDS pre-tied loops and resected.

We have performed 135 laparoscopic inguinal hernia inversion and ligations in female children ranging from 1 month to 18 years of age in the past 5 years. We have had no peri-operative complications or conversions to open. We have had 1 recurrence in our series which occurred in our first case when we did not resect the hernia sac. We subsequently routinely resect the sac and consider this to be critical in preventing recurrence.

We believe that a laparoscopic technique involving inversion and ligation of the hernia sac is safe and effective in the pediatric female population.