Optimizing adolescent inguinal hernia repair: a comprehensive robotic-assisted laparoscopic approach

PURPOSE: Consensus guidelines for the management of adolescent inguinal hernia repair remain lacking. While high ligation remains common among pediatric surgeons, mesh-based floor reinforcement is selectively used by some surgeons for adolescents with larger or more complex hernias. Consequently, significant variability exists in the surgical management of adolescents with inguinal hernias. In this study, we describe an institutional algorithm that utilizes an individualized approach to adolescent inguinal hernia repair. METHODS: We conducted a retrospective analysis of adolescents aged 12-18 years who underwent laparoscopic inguinal hernia repair (LIHR) or robotic-assisted transabdominal preperitoneal (rTAPP) inguinal hernia repair with mesh over a four-year period, following a standardized decision-making algorithm. If on initial diagnostic laparoscopy there was a processus vaginalis > 2 cm, long hernia sac with scrotal component, or direct component, we proceeded with rTAPP. Otherwise, LIHR was performed. RESULTS: 44 adolescents underwent inguinal hernia repair using this algorithm. For LIHR, median (IQR) operative time, age, and weight were 20 min (13-38), 15 years (14-16), and 59 kg (53-66), respectively. For rTAPP, these were 115 min (105-133), 16 years (15-17), and 67 kg (58-77), respectively. Only operative time was statistically significant between the two cohorts. There were neither conversions to open, postoperative admissions, nor instances of recurrence to date. CONCLUSION: Our institution successfully implemented a tailored algorithm for adolescent hernia repair based on age and hernia characteristics. Mesh was well tolerated without additional morbidity and no recurrences during available follow-up. This highlights the safety, effectiveness, and relevance of a customized algorithm in this unique population.