Laparoscopic ligation of internal ring-three ports versus single-port technique: are working ports necessary?

Abstract Background: From three ports, technical refinements in laparoscopy have facilitated the ligation of the internal ring (IR) with a single port. Objectives: The aims of this study were to determine whether, when, and where working ports are needed by assessing the differences in outcome between the three-port technique (TPT) and the single-port technique—subcutaneous endoscopically assisted ligation (SEAL). Methods: Short-term outcomes of 163 children operated on by either technique (51 with TPT, and 112 with SEAL) were audited. Technical difficulties, operation time, intra- and postoperative complications, and postoperative stay were studied. Results: IR could be ligated faster by SEAL than TPT (unilateral: 15 vs. 25 minutes; P = 0.0005; bilateral: 25 vs. 40 minutes; P = 0.001). SEAL proved cosmetically more appealing (one 5-mm vs. three 5-mm scars). Complication rates, recovery, and hospital stay were similar. Recurrences were marginally higher following SEAL (4.8 vs. 2.98%; P = 0.49). Intracorpo...