Mesh-free laparoscopic inguinal sac resection in adolescents: multicenter outcomes of a sac-resection approach for...

Adolescent indirect inguinal hernia occupies a transitional space between pediatric and adult hernia practice, with ongoing debate regarding mesh-based versus non-mesh repair. Laparoscopic inguinal sac resection (LISAR) is a sac-oriented technique that removes the indirect hernia sac circumferentially at the internal ring without mesh placement and without routine internal ring closure. We aimed to describe the feasibility, perioperative safety, and clinically observed early-to-midterm outcomes of LISAR in adolescents.

We performed a multicenter retrospective case series across four institutions including 146 adolescents aged 12-18 years who underwent LISAR for indirect inguinal hernia between 2003 and 2024. Internal ring closure was used selectively when the defect appeared wide or peritoneal apposition was judged insufficient. Recorded outcomes included conversion, intraoperative and early postoperative complications, urologic sequelae, recurrence, operative time, internal ring closure, and follow-up.

The cohort included 124 males and 22 females. Repairs were unilateral in 132 patients and bilateral in 14, totaling 160 repairs. All procedures were completed laparoscopically, with no conversions or intraoperative complications. Internal ring closure was performed in 6 patients (4.1%); the remaining 140 patients underwent sac resection alone. No early postoperative complications, urologic sequelae, reoperations, or clinically detected recurrences were observed. All patients completed 3-month follow-up; 134 (92.0%) had follow-up ≥ 12 months.

In this multicenter adolescent case series, LISAR was feasible and was not associated with observed perioperative morbidity, urologic sequelae, or clinically detected recurrence during available follow-up. These findings support further prospective evaluation of sac-oriented, mesh-free laparoscopic repair in adolescents.