Optimizing surgical techniques for the repair of inguinal hernias in infants

Zane J Hellmann ¹, J Leslie Knod ², Afif N Kulaylat ³

¹Yale New Haven Children's Hospital, Division of Pediatric Surgery, New Haven, CT, USA.
²Connecticut Children's Medical Center, Division of Pediatric Surgery, Hartford, CT, USA.
³Penn State Health Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA.
⁴Cleveland Clinic Children's Hospital, Division of Pediatric Surgery, Cleveland, OH, USA.
⁵Massachusetts General Hospital, Division of Pediatric Surgery, Boston, MA, USA.
⁶New York-Presbyterian Morgan Stanley Children's Hospital, Division of Pediatric Surgery, New York, NY, USA.
⁷Emory University School of Medicine - Children's Healthcare of Atlanta, Division of Pediatric Surgery, Atlanta, GA, USA.
⁸UPMC Children's Hospital of Pittsburgh, Division of Pediatric General and Thoracic Surgery, Pittsburgh, PA, USA.
⁹Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatric Surgery, Nashville, TN, USA.
¹⁰Johns Hopkins Children's Center, Division of General Pediatric Surgery, Baltimore, MD, USA.
¹¹Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
¹²Golisano Children's Hospital, Division of Pediatric Surgery, Rochester, NY, USA.
¹³Children's of Alabama, Division of Pediatric Surgery, Birmingham, AL, USA.
¹⁴Children's National Hospital, Department of General and Thoracic Surgery, Washington, DC, USA.
¹⁵Atrium Health Wake Forest Baptist - Brenner Children's Hospital, Division of Pediatric Surgery, Winston-Salem, NC, USA.
¹⁶Johns Hopkins All Children's Hospital, Division of Pediatric Surgery, St. Petersburg, FL, USA.
¹⁷University of Florida Health Shands Children's Hospital, Division of Pediatric Surgery, Gainesville, FL, USA.
¹⁸Cohen Children's Medical Center, Division of Pediatric Surgery, New Hyde Park, NY, USA.

⁰Yale New Haven Children's Hospital, Division of Pediatric Surgery, New Haven, CT, USA.

Journal of Pediatric Surgery +

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November 27, 2025

View abstract on PubMed

Summary

For infants under 6 months, specific techniques in inguinal hernia repair (IHR) can significantly lower recurrence rates. Cauterizing the internal ring and using permanent sutures in laparoscopic IHR, or performing diagnostic laparoscopy in open IHR, are key findings.

Area Of Science

Pediatric Surgery
Minimally Invasive Surgery
Hernia Repair Outcomes

Background

Laparoscopic inguinal hernia repair (IHR) is increasingly used in infants, but data comparing techniques and outcomes to open IHR are limited.
This study focuses on infants under 6 months undergoing primary IHR.

Purpose Of The Study

To evaluate the impact of specific surgical techniques on subsequent inguinal hernia rates in infants.
Investigating the effect of internal ring cauterization and permanent suture use in laparoscopic IHR.
Assessing the benefit of diagnostic laparoscopy during open IHR.

Main Methods

A multicenter retrospective study of 1532 infants (<6 months) who underwent primary IHR between 2018-2019.
Data collected on patient demographics, operative techniques (laparoscopic vs. open), and subsequent hernia incidence.
Analysis focused on recurrent ipsilateral and metachronous contralateral hernias.

Main Results

Laparoscopic IHR with ring cauterization and permanent sutures showed significantly lower ipsilateral recurrence (0.5%) compared to standard laparoscopic IHR (6.2%).
Open IHR with diagnostic laparoscopy had significantly lower contralateral recurrence (1.4%) compared to standard open IHR (3.8%).
Recurrence rates with these specific techniques were comparable to the alternative surgical approach.

Conclusions

Cauterizing the internal ring and using permanent sutures during laparoscopic IHR reduces subsequent hernia rates in infants.
Performing diagnostic laparoscopy during open IHR also lowers subsequent hernia rates in this population.
These techniques offer improved outcomes for primary inguinal hernia repair in infants <6 months old.

Keywords:

Infants Laparoscopic inguinal hernia repair Metachronous contralateral hernia Open inguinal hernia repair Recurrent ipsilateral hernia