Laparoscopic Inguinal Hernia Repair (Hernia Sac Resection and Peritoneal Closure) in Children at a Single Institution: Surgical Techniques and Outcomes

Abstract

Purpose: Various laparoscopic techniques for pediatric inguinal hernia repair have been reported globally. In Japan, most institutions employ the laparoscopic percutaneous extraperitoneal closure (LPEC) technique described by Takahara (2000). Since 2018, our institution has adopted a novel approach involving circumferential hernia sac disconnection and continuous suture closure of the peritoneum. In this paper, we describe the surgical technique and evaluate its clinical outcomes.

Methods: A retrospective review was conducted on 107 patients (27 boys, 80 girls) who underwent this technique between April 2018 and March 2023. In all patients, the laparoscopic technique was performed using a three-port approach with a 3-mm 0-degree laparoscope and 3.5-mm working ports.

Results: The median age at surgery was 67.5 months (range: 9–192). There were 39 (36.5%) unilateral and 68 (63.5%) bilateral cases, including 100 inguinal hernias, six hydroceles, and one hydrocele of the canal of Nuck. The mean operative times were 47 minutes for unilateral cases and 67 minutes for bilateral cases. No intraoperative complications occurred, and no ipsilateral recurrence or metachronous contralateral hernia has been observed. A contralateral patent processus vaginalis was identified in 57 (58.7%) of 97 unilateral cases. One case of postoperative umbilical infection was noted.

Conclusion: This technique ensures complete hernia sac disconnection while preserving the spermatic cord structures, minimizing the risk of injury. Further research is needed to improve this technique and increase surgical efficiency.