Laparoscopic-assisted extraperitoneal ligation versus intraperitoneal suturing for pediatric inguinal hernia repair: a multicenter, observational study of recurrence.

Background: This study aimed to retrospectively compare postoperative recurrence rates between laparoscopic-assisted extraperitoneal closure and intracorporeal suturing for pediatric inguinal hernia (PIH) repair across multiple centers, and to investigate the clinical causes of recurrence to inform surgical practice.

Methods: This is a retrospective review of 5244 PIH repairs performed using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) at the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University between January 2017 and December 2020. In addition, 6054 PIH repairs were performed using two-port laparoscopic intracorporeal suturing (TPLIS) at the Capital Center for Children's Health, Capital Medical University between January 2015 and December 2020. All patients were followed for 2 years with intraoperative findings at reoperation documented and causes of recurrence analyzed.

Results: There was recurrence in 30 SPLPEC cases (27 males, 3 females; mean interval to recurrence, 7.6 months). There was a recurrence in 35 TPLIS cases (31 males, 4 females; mean interval, 12.5 months). There was no statistically significant difference in recurrence rates (p=0.966). Laparoscopic re-exploration identified omitted or torn peritoneum (n=42), lipidosis in the abdominal wall (n=7), and loose knots (n=16) as the primary causes of recurrence. No further recurrences were seen in the SPLPEC group after reoperation. In the TPLIS group, 33 patients had favorable outcomes, 2 patients experienced a second recurrence.

Conclusions: The incidence of PIH in females may be higher than previously recognized. Both SPLPEC and TPLIS demonstrated low recurrence rates, particularly among females and the second operation proved to be an effective treatment option for recurrent cases. For SPLPEC in obese children, secure ligation of the hernia internal ring is essential to prevent recurrence. TPLIS requires extended follow-up to detect possible late recurrence.