A classification-guided laparoscopic strategy for adult indirect inguinal hernias: preliminary experience with the single-port percutaneous internal ring suture technique

Abstract Background Adult inguinal hernia is a heterogeneous condition with distinct anatomical subtypes. Laparoscopy allows accurate classification of hernia type and may facilitate tailored surgical decision-making. While mesh-based repair remains the standard treatment in adults, the optimal strategy for indirect inguinal hernia continues to be debated. This study evaluated the feasibility of a classification-guided laparoscopic approach for adult inguinal hernia, with particular focus on the selective application of the single-port percutaneous internal ring suture (SPIRS) technique in patients with indirect hernias. Methods Adult patients with clinically suspected inguinal hernia underwent routine laparoscopic inspection for accurate classification of hernia subtype. Surgical strategy was individualized according to laparoscopic classification. Patients with indirect inguinal hernia were treated using the SPIRS technique, whereas other subtypes were managed with mesh-based repair. Perioperative outcomes, recurrence, postoperative pain, and long-term follow-up results were retrospectively analyzed. Results From July 2018 to February 2022, 82 adult patients underwent laparoscopic classification followed by tailored surgical management. Indirect inguinal hernias were identified in 70% of male and 82% of female patients. SPIRS was selectively performed in patients with indirect hernias. Mean follow-up exceeded 60 months. Two recurrences (3.2%) occurred during the early phase of the series, both in patients with large internal ring openings (EHS3), and were successfully managed with repeat repair following technical refinement. One patient developed chronic postoperative inguinal pain, which resolved completely after removal of the previous suture. Most patients resumed daily activities within a few days, and no major perioperative complications were observed. Conclusion A classification-guided laparoscopic approach enables tailored management of adult inguinal hernia. Within this framework, SPIRS may be selectively applied to carefully chosen adult patients with indirect inguinal hernias, particularly those with small- to moderate-sized indirect hernias, with acceptable mid- to long-term outcomes. Further prospective studies are warranted to refine patient selection and optimize technique.