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Laparoscopic inguinal sac resection (LISAR): A multicenter retrospective case series over two decades in pediatric
Mario Riquelme1, Carlos Garcia-Hernandez2, Alejandro Cendejas-Higueras3
1Pediatric Surgeon, Christus Muguerza Hospital, Monterrey, Nuevo Leon, Mexico.
Insights
Laparoscopic Inguinal Sac Resection (LISAR) is a safe and effective pediatric hernia repair method. This 22-year study shows LISAR achieves low recurrence and minimal complications without routine ring closure.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic pediatric inguinal hernia repair often uses internal ring ligation.
- Laparoscopic Inguinal Sac Resection (LISAR) excises the hernia sac at its origin, similar to open surgery principles.
- LISAR does not routinely involve internal ring closure.
Purpose of the Study:
- To evaluate the long-term outcomes of Laparoscopic Inguinal Sac Resection (LISAR) in pediatric patients.
- To assess recurrence rates, postoperative complications, and urologic sequelae associated with LISAR.
- To determine the safety and efficacy of LISAR over a two-decade period.
Main Methods:
- A retrospective multicenter case series included patients aged 1 month to 18 years undergoing LISAR for indirect inguinal hernia from January 2003 to December 2024.
- Data collected included patient demographics, laterality, concurrent orchidopexy, and internal ring closure status.
- Primary outcomes were recurrence, early postoperative complications (≤30 days), urologic sequelae, and conversion to open surgery.
Main Results:
- 1203 patients (1424 repairs) underwent LISAR, with a mean operative time of 26.0 minutes.
- No conversions to open surgery were recorded. Early complications occurred in 0.17% of patients, and urologic sequelae were absent.
- The overall recurrence rate was 0.58% per patient, with all recurrences in cases without internal ring closure. Adolescents showed no recurrences or complications.
Conclusions:
- LISAR, performed over 22 years across three centers, demonstrates low recurrence rates and minimal morbidity.
- The technique achieved zero conversions to open surgery and negligible early complications.
- A standardized sac-resection approach without routine ring closure is a safe and effective method for pediatric and adolescent inguinal hernia repair.
Background:
Laparoscopic pediatric inguinal hernia repair is commonly performed with internal ring ligation (e.g., PIRS/LPEC). Laparoscopic Inguinal Sac Resection (LISAR) excises the sac at its origin without routine ring closure, mirroring the open principle of complete sac resection. We evaluated long-term outcomes of LISAR across two decades.
Methods:
Retrospective multicenter case series of consecutive patients aged 1 month-18 years who underwent LISAR for indirect inguinal hernia (January 2003-December 2024) at three tertiary centers. Prespecified descriptors: sex, adolescent subgroup (12-18 years), laterality, concurrent orchidopexy, and internal ring closure.
Primary Outcomes:
recurrence, early postoperative complications (≤30 days), urologic sequelae, and conversion to open surgery.
Secondary Outcomes:
total operative time, and long-term follow-up.
Results:
1203 patients (1424 repairs) underwent LISAR: 1009 males (83.9 %), 194 females; 221 bilateral (18.4 %); 142 adolescents (11.8 %). Concurrent orchidopexy was performed in 62 (5.2 %). Internal ring closure was selective (55/1203; 4.6 %). Mean operative time (pooled) was 26.0 min. There were no conversions (0/1203). Early complications occurred in 2/1203. Urologic sequelae were 0/1009. Recurrence was 0.58 % per patient (7/1203) and 0.49 % per repair (7/1424); all recurrences occurred in non-closure cases. Long-term follow-up (≥30 days) was documented for 100 % of patients; cohort-weighted mean duration was 57.3 months. In adolescents, there were no recurrences, conversions, or early complications (0/142).
Conclusions:
Over 22 years in three centers, LISAR achieved low recurrence, no conversions, and minimal morbidity. A standardized sac-resection approach without routine ring closure appears safe and effective in children and adolescents.
