However, the operative time is reduced with experience. It is well documented that the limiting step in laparoscopic hernia repair is the intracorporeal suturing of the IIR [2, 5]. In OH, time is consumed new in gaining access, obtaining adequate exposure, in localizing and isolating the sac from the cord structures. In laparoscopic surgery, approaching the hernial defect from within the abdomen, makes the area of interest bloodless, and the magnification renders anatomy very clear, making surgery precise [13, 15, 20]. With growing experience and use of refinements, such as hydrodissection and needle sign, operative time does come down. Chan and Tam found that laparoscopic surgery is marginally quicker (5min), but this difference appears insignificant, both statistically and in practice [18].
In our series the operative time is less than that reported in the literature as we use an easy simple and rapid technique for repair of IH using RN which can be done with far great ease in a very short time. Also, we used the extracorporeal suture ligation which is less time consuming [21]. Different laparoscopic techniques for repair of IH in children were reported in the literature. Schier (1998) used 2mm instruments without a trocar for intra-abdominal suturing of the open inguinal rings in 25 girls by the placement of two Z-sutures with good results [17]. Bharathi et al. stated that SEAL resulted in marked reduction of operative time than TNH technique (unilateral, 15 versus 25 minutes, and bilateral, 25 versus 40 minutes).
They added that avoiding the vas deferens and testicular vessels during SEAL repair in males may leave a small gap at the internal ring as well as leaving the hernial sac in situ, which has the potential to contribute to a higher incidence of hydrocele and recurrence in male patients [8, 21]. Yang et al. reported that laparoscopic herniorrhaphy is superior to open herniotomy in the repair of bilateral IH and lower rate of metachronous contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates [22]. Endo and Ukiyama introduced the Endoneedle that is designed specifically for laparoscopic extraperitoneal closure of the patent processus vaginalis [23]. Lee and Liang performed microlaparoscopic high ligation in 450 patients with good results.
They reported no complications Batimastat of the surgery and a remarkably low recurrence rate (0.88%) [5]. Marte et al. stated that the incision of the peritoneum lateral to the internal inguinal ring and the W-shaped suture, compared to the sole W-shaped suture, is safe and effective in preventing hernia recurrence [24]. Open herniotomy in children has been reported to have recurrence rates of 0.8�C3.8% [8]. While in laparoscopic hernia repair it is ranged from 0.7% to 4.5%.