Laparoscopic Techniques in Pediatric Inguinal Hernia Repair

Laparoscopic repair of paediatric inguinal hernia has evolved from a novel investigation into a well-established alternative to open herniotomy. By using small ports and high-definition optics, surgeons can perform high ligation of the hernia sac under direct vision, inspect and manage a contralateral patent processus vaginalis, and minimise tissue trauma. Techniques range from multi-port intracorporeal suturing to single-port extraperitoneal closure, often employing specialised needles or hydrodissection to separate peritoneum from cord structures. Reported benefits include reduced postoperative pain, faster return to activity, improved cosmesis and lower rates of metachronous contralateral hernia. Learning curves vary by approach, with percutaneous extraperitoneal closure generally requiring fewer cases to reach proficiency. Global experience has grown, with high-volume centres reporting reproducible outcomes and early adoption in resource-limited settings. Future refinements focus on instrument ergonomics, suture materials and integration of imaging to further enhance safety and efficacy.

Research from Nature Portfolio

Recent clinical series comparing single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) using double-modified hernia needles with hydrodissection against two-port percutaneous extraperitoneal closure have demonstrated the safety and effectiveness of the single-port method in children with giant indirect hernias. Compared with the two-port approach, SLPEC yielded shorter operative times, less intraoperative bleeding, lower pain scores and faster postoperative mobilisation, while maintaining comparable hospital stay, costs and complication rates. Cosmetic outcomes were superior, with minimal scarring and no increase in hernia recurrence or testicular complications. These findings support SLPEC as a minimally invasive, reproducible technique with potential for widespread adoption in paediatric practice.

Laparoscopic Techniques in Pediatric Inguinal Hernia Repair publication trend

The graph below shows the total number of articles in laparoscopic techniques in pediatric inguinal hernia repair across all publications each year (not limited to Nature Index journals).

Technical terms

Laparoscopic percutaneous extraperitoneal closure (LPEC): A minimally invasive technique in which sutures are placed around the internal ring via a needle passed outside the peritoneal cavity, allowing high ligation of the hernia sac without extensive intracorporeal suturing.

Intracorporeal suturing: The placement and tying of sutures entirely within the peritoneal cavity using laparoscopic instruments through separate ports.

Extracorporeal suturing: A method of ligation in which the suture is tied outside the body and then advanced to close the internal ring, typically via a single port.

Contralateral patent processus vaginalis (CPPV): A persistent channel between the peritoneum and inguinal canal on the opposite side of the clinically apparent hernia, which may lead to a future herniation.

Metachronous contralateral inguinal hernia (MCIH): A hernia that develops on the opposite side after initial unilateral repair, often detected intraoperatively during laparoscopic inspection.

References

1. A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles. Scientific Reports (2024).
2. Comparison of intra- and extra-corporeal laparoscopic hernia repair in children: A systematic review and pooled data-analysis. Journal of Pediatric Surgery (2021).
3. A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China. BMC Surgery (2020).
4. Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis. Surgical Endoscopy (2019).
5. The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees. BMC Surgery (2019).