Innovations in laparoscopic inguinal hernia repair increasingly favor techniques that minimize trauma and eliminate dependence on costly fixation devices. We developed a novel method—INKA (INtra-abdominal Knotting Approach)—which allows mesh fixation via extracorporeal suture manipulation while anchoring the mesh securely within the abdominal cavity.

We retrospectively analyzed 13 patients (11 males, 2 females) who underwent laparoscopic herniorrhaphy using the INKA technique. Key parameters included patient demographics, hernia type, pathology findings, intraoperative blood loss, mesh usage, and operative duration. Hernia types were categorized per procedure (i.e., each side analyzed separately), and pathology specimens were reviewed. Operation time was measured from skin incision to closure.

A total of 20 hernia procedures were performed across 13 patients using the INKA technique. The recurrence rate was 7.69% (1 out of 13 patients). Common comorbidities included hypertension (n=4), cardiovascular disease (n=3), and liver disease (n=3), while recognized hernia risk factors included exertion (n=2), voiding difficulty due to BPH (n=1), and elevated intra-abdominal pressure from constipation or ascites (n=2). The mean operative time was 198.8 minutes (range: 127.8–320.0 minutes). Lipoma was found in 8 procedures, with a mean operative time of 192.9 ± 56.5 minutes, while the presence of a hernia sac (n=3) did not increase operative time (175.1 ± 30.8 minutes) compared to procedures without a sac (197.6 ± 59.1 minutes). Mesh was used in 10 procedures and was associated with a longer operative time (218.9 ± 60.5 minutes) than procedures without mesh (158.5 ± 42.9 minutes), likely reflecting greater case complexity. In per-procedure analysis, direct hernias (n=11) had a mean operative time of 199.6 ± 54.5 minutes, while indirect hernias (n=9) averaged 206.0 ± 56.0 minutes. Blood loss was similar across groups (direct: 16.8 ± 13.3 ml; indirect: 17.8 ± 14.6 ml), and mesh use rates were comparable (72.7% for direct vs. 77.8% for indirect).

The INKA technique is a reproducible and minimally invasive approach that accommodates a wide range of hernia types, including direct, indirect, and recurrent cases. Its extracorporeal knotting system simplifies fixation, achieves consistent outcomes, and demonstrates operative efficiency regardless of pathology or hernia configuration.