Laparoscopic pediatric inguinal hernia repair: our experience with the LSDS technique in an emerging tertiary care centre

Inguinal hernia repair is one of the most common operations performed by pediatric surgeons. Open herniotomy has long been the preferred technique, with a recurrence rate ranging from 0 to 6%. The laparoscopic sac dissection and suture ligation (LSDS) approach replicates the open method while allowing inspection of both inguinal rings. The incidence of metachronous hernia after open repair has been reported to be around 30%. We conducted a prospective case-series analysis of laparoscopic pediatric inguinal hernia repairs performed between April 2022 and March 2025 at a suburban tertiary hospital. A total of 101 children underwent 118 LSDS procedures. Two children (2%) presented with bilateral hernias, and 15 (14.8%) were found intraoperatively to have a contralateral patent processus vaginalis (CPPV). Nine children (8.9%) required additional narrowing of the deep inguinal ring, which was achieved by suturing the conjoint tendon to the reflected part of the inguinal ligament. One child experienced recurrence, and no metachronous hernias were observed. In this descriptive study, laparoscopic inguinal hernia repair proved to be a safe and effective technique in the pediatric population. It demonstrated favorable outcomes, including a low recurrence rate and the absence of metachronous hernia during follow-up. Controlled thermal injury and narrowing of the musculo-aponeurotic aperture appeared to further reduce recurrence. However, larger studies with longer follow-up periods are required to validate these results and identify which hernial ring characteristics may benefit from additional posterior wall reinforcement.