Pediatric laparoscopic herniotomy - Is peritoneal closure essential in small internal ring diameter, a prospective observational study

Abstract Introduction: Pediatric inguinal hernia is a common surgical condition, traditionally managed with open herniotomy. Laparoscopic techniques are increasingly preferred due to their minimally invasive nature. However, the optimal approach to hernia sac management with and without peritoneal closure after sac excision remains debatable. Objective: To compare short-term clinical outcomes of laparoscopic hernia sac management with and without peritoneal closure after sac excision in pediatric patients. Methods: A prospective observational study was conducted at a single tertiary care center, between February 2023 and January 2025. Fifty children aged 6 months–14 years with indirect inguinal hernia and internal ring diameter <10 mm were allocated into two equal groups: Group A (laparoscopic herniotomy with peritoneal closure) and Group B (laparoscopic herniotomy without closure of peritoneum). Outcome measures included operative time, intraoperative and postoperative complications, pain scores, hospital stay, and recurrence at 6 months. Results: A total of 50 children were included in the study, with 25 children in each group. Group B demonstrated a slightly shorter operative time (42.1 ± 7.5 min) compared to Group A (45.3 ± 8.7 min; P = 0.17). No significant differences were found in intraoperative blood loss ( P = 0.25) and postoperative pain (Visual Analog Scale) ( P = 0.42). Recurrence was observed in 4% (1/25) of Group A and 8% (2/25) of Group B. Postoperative complications, including residual scrotal fluid and wound infections, were minimal and comparable across groups. Conclusion: Both techniques are effective and safe. No significant statistical difference was identified between both the methods. With respect to operative time, nonclosure of peritoneum has a shorter but not statistically significant difference. Technique selection should be individualized based on surgical expertise and intraoperative findings. The observed numerical difference would require a much larger study to validate.