Clinical features and misdiagnosis analysis of pediatric inguinal direct hernia: a single-center retrospective study of 23 cases

Objective To investigate the clinical characteristics and common etiologies of misdiagnosis in pediatric direct inguinal hernia. Methods A retrospective analysis was conducted on 23 pediatric cases of direct inguinal hernia treated at Wuhan Children's Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology, from September 2020 to September 2025. The cohort comprised 18 male and 5 female patients, aged from 3 months to 13 years and 6 months, with a median age of 4 years and 5 months. Results All 23 cases were initially misdiagnosed as indirect inguinal hernia preoperatively. Among these, 10 cases were correctly identified as direct inguinal hernia during the initial surgical intervention. Eleven patients underwent high ligation of the hernia sac due to misdiagnosis, subsequently developing ipsilateral inguinal masses postoperatively, which were confirmed as direct inguinal hernia during laparoscopic reoperation after an average interval of 4.7 months. Two patients were found to have contralateral direct inguinal hernia incidentally during their second surgery for ipsilateral indirect inguinal hernia, with simultaneous repair performed. Surgical management included laparoscopic ligation of the direct hernia orifice combined with medial umbilical ligament reinforcement for direct hernias, and laparoscopic high ligation of the hernia sac for indirect hernias. A total of 26 direct hernia repairs were performed in 23 patients, including 12 left-sided, 14 right-sided, 3 bilateral, and 3 Pantaloon hernias. Postoperative follow-up ranged from 1 month to 5 years, with no instances of recurrence or complications such as hematoma, wound infection, or testicular atrophy. Conclusion The diagnosis of direct inguinal hernia presents significant challenges, with intraoperative misdiagnosis being the primary cause of reoperation in pediatric cases. Intraoperative downward and inward traction of the medial umbilical ligament facilitates better visualization of the direct hernia ring. Laparoscopic management of pediatric direct inguinal hernia demonstrates safety, efficacy, and low complication rates, warranting broader clinical application.