Factors associated with recurrence after laparoscopic inguinal hernia repair in preterm infants

Laparoscopic inguinal hernia repair (LIHR) is increasingly adopted in pediatric surgery due to its advantages over open inguinal hernia repair, but outcomes in infants, especially preterm infants, are not well established. This study aimed to evaluate the characteristics and outcomes of LIHR in infants and identify factors associated with recurrence in preterm infants. A retrospective analysis was conducted on infants younger than 12 months who underwent LIHR at two tertiary hospitals, from March 2018 to August 2022. A total of 119 infants (62 preterm, 57 full-term) were included. All surgeries were performed by a single experienced pediatric surgeon using a standardized LIHR technique. Data on patient demographics, surgical details, and outcomes were collected and analyzed to compare outcomes and identify risk factors for recurrence. Preterm infants had significantly lower gestational age, birth weight, postconceptional age (PCA), and body weight at operation. They exhibited higher rates of bilateral hernias, contralateral patent processus vaginalis, postoperative hydrocele, need for mechanical ventilation, and longer hospital stays. Recurrence occurred in 6.4 % of preterm infants and none in full-term infants. Multivariable analysis identified incomplete hernia sac transection (OR 22.57, p = 0.042) and PCA <39.07 weeks (OR 70.52, p = 0.008) as significant risk factors for recurrence in preterm infants. LIHR is feasible and effective in both preterm and full-term infants, but preterm infants have higher risks of postoperative complications and recurrence. Delaying surgery until the PCA exceeds 39.07 weeks and ensuring complete hernia sac transection may reduce recurrence risk in this vulnerable population.