Laparoscopic percutaneous extracorporeal ligation of an indirect inguinal hernia in an infant

(A) The laparoscopic appearance of a left indirect inguinal hernia with patent processus vaginalis (PV) in an infant, with the relative locations of the vas deferens (VD), testicular vessels (TV), inferior epigastric artery (IEA), and medial umbilical ligament (MUL).

(B) The peritoneum of the internal inguinal ring is cauterized.

(C) A needle is passed percutaneously in the pre-peritoneal space (superficial to the vas deferens and testicular vessels) around one hemi-circumference (arrow) of the internal ring.

(D) Safe passage of a suture.

(E) A second needle pass around the other hemi-circumference (arrow) allows complete ligation of the patent processus vaginalis while protecting the vas deferens and testicular vessels.