As almost all of the inguinal hernias (IHs) are indirect type (IIH), laparoscopic percutaneous internal ring suture (PIRS) had been well developed and proved to be an effective and safe method for the repair of IH in the pediatric and young adolescent group since Dr. Patkowski first introduced this technique. The principle of PIRS was to close the internal ring opening (IRO) at the preperitoneal level using a nonabsorbable suture with the assistance of laparoscopy.

The surgery was performed as we previously described. Under general anesthesia, the patient was put in a supine position. By grasping and elevating the bilateral abdominal wall, a 3-mm sharpheaded trocar was inserted directly into the abdominal cavity via umbilicus, followed by a 3-mm zerodegree scope to confirm the successful trocar placement. Pneumoperitoneum was then established with intra abdominal pressures set at 15 mmHg for adults and 6–12 mmHg for children. The subtype of an IH was easily identified by viewing the posterior abdominal wall laparoscopically. To customize the treatment, an SPIRS would be carried out if IIH encountered, while mesh repair be performed for the other types (eg. direct, mixed, or femoral) of IH. If there was no abdominal wall defect found under laparoscopy, the inguinal region would be explored by open method.

This is a 78-year-old male without systemic disease. He suffered from right inguinal hernia for months, and came to our OPD for help. After discussing, he decided to accept single‑port laparoscopic percutaneous internal ring suture. No obvious complications after operation, and the scar was nearly invisible one-week post-op.

The tailored approach of treating IIHs using the single-port laparoscopic percutaneous internal ring suture appears promising and could serve as an alternative for managing IHs. However, further investigations comparing this method to traditional techniques are warranted.