A Multicenter Comparative Study on Laparoscopic-Assisted Extraperitoneal Ligation Versus Intraperitoneal Suturing in Pediatric Inguinal Hernia Postoperative Recurrence

Background: To retrospectively compare postoperative recurrence rates of laparoscopic-assisted extraperitoneal closure versus intracorporeal suturing for pediatric inguinal hernias(PIH) across multiple centers, and to explore the clinical reasons for recurrence and guide surgical practice. Methods: A retrospective review was conducted of 5,244 cases of PIH surgeries performed using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC), as the SPLPEC group. Additionally, 6,054 cases were treated using two-port laparoscopic intracorporeal suturing (TPLIS), as the TPLIS group. Follow-up was conducted for over 2 years, with recorded findings from reoperations analyzed for causes of recurrence. Results: In SPLPEC group, there were 30 cases of postoperative recurrence (27 male, 3 female) with an average recurrence interval of 7.6 months. In TPLIS group, there were 35 cases of recurrence (31 male, 4 female) with an average interval of 12.5 months. Based on findings during reoperation, the causes of recurrence were classified into omitted or torn peritoneum (42 cases), hypertrophic abdominal wall (7 cases), and loose knots (16 cases). No further recurrences were observed in the SPLPEC group after the second surgery; in the TPLIS group, 33 cases had good outcomes in post-second laparoscopic surgery, while 2 cases recurred. Conclusion: Both SPLPEC and TPLIS techniques yield low recurrence rates for inguinal hernias. Children with recurrence generally respond well to repeat laparoscopic repair. However, when performing SPLPEC on obese children, it is crucial to ensure secure ligation of the hernia internal ring (IIR) to prevent recurrence, and patients undergoing TPLIS require longer follow-up periods to monitor for potential recurrence.