Laparoscopic Iliopubic Tract Repair for Acquired Pediatric Inguinal Hernia

Abstract

Background:

Most pediatric inguinal hernias (PIH) result from congenital patency of the processus vaginalis; however, a subset arises from acquired mechanisms involving posterior wall weakness. Representative examples include direct hernias and metachronous contralateral inguinal hernias (MCIH) that develop following negative laparoscopic exploration. In such cases, high ligation alone may be insufficient. This study aimed to evaluate the outcomes of laparoscopic iliopubic tract repair (IPTR) in acquired PIHs, focusing on recurrence, surgical outcomes, and safety.

Methods:

From January 2013 to December 2022, 12,792 pediatric patients younger than 10 years underwent laparoscopic inguinal hernia repair. Among them, 21 patients diagnosed with acquired PIHs were treated with laparoscopic IPTR. The repair involved suturing the iliopubic tract to the transversalis fascia using nonabsorbable suture to reinforce the posterior wall. We evaluated surgical outcomes, including recurrence and safety.

Results:

Of the 21 patients, 10 had direct hernias and 11 had indirect hernias of MCIH that were initially negative on laparoscopic evaluation but later developed into clinical PIHs. Compared with indirect PIH, direct PIH occurred in patients who were significantly older and heavier (P = .017 and P = .020, respectively). The omentum was the sole herniated organ in direct cases (P < .001). All surgeries were completed laparoscopically without conversion, and no intraoperative or postoperative complications occurred. At a median follow-up of 78 months, no recurrences were observed.

Conclusions:

Laparoscopic IPTR is a safe and effective surgical approach for acquired PIHs. It provides reliable posterior wall reinforcement and may reduce the risk of recurrence.