Modified Percutaneous Internal Ring Suture PIRS Technique for Inguinal Hernia Repair in Girls, Can It Be Even Better?

Introduction: The percutaneous internal ring suturing (PIRS) technique is known for its simplicity and superior cosmetic outcomes. Alternatively, induced peritoneal injury as in Godoy Burnia technique involves the use of instruments to invert and cauterize the hernial sac. We present a novel approach that integrates the strengths of both techniques, offering a time-efficient and reliable method with low recurrence rates while maintaining excellent cosmetic results.Methods: This is a retrospective analysis of laparoscopic inguinal hernia in female patients using the modified PIRS technique. Patients’ records were analyzed for operative time, complications, recurrence, and cosmetic outcome. In all patients, 18-gauge venipuncture needles were manually modified into a J-shaped curved tip allowing percutaneous introduction of a non-absorbable 2/0 suture encircling the internal ring followed by cauterization of the sac at the level of internal ring using sealed 18-gauge cannula under laparoscopic visualization without instruments.Results: Fifty-eight female patients with ages ranging from 1 to 11 years (average 2.8 years) operated over 8-year-period (2016-2023). Average operative time for the 42 unilateral cases was (11.8 minutes), while for the 16 bilateral cases was (20.4 minutes). All patients were followed up for at least 6 months. No recurrences or stitch sinuses were noted, however two patients complained from a palpable subcutaneous suture, and 5 cases had minimal retro-peritoneal hematoma. All parents were satisfied with the cosmetic results.Conclusion: The combination of cauterization of the hernial sac with percutaneous internal ring ligation under laparoscopic visualization is an effective, reproducible, and safe technique. It demonstrates high reliability, excellent cosmetic outcomes, and no increased risk of recurrences.