Laparoscopic management of a pediatric pantaloon hernia with contralateral patent processus vaginalis: a case report

Pediatric direct inguinal hernia is a rare entity, and the coexistence of ipsilateral indirect and direct inguinal hernias (pantaloon hernia) is even more uncommon. Consequently, pediatric surgeons have limited experience with this entity. We report a 12-year-old boy who presented with a reducible right inguinal mass. Laparoscopy revealed a right-sided pantaloon hernia (predominantly indirect) and a contralateral patent processus vaginalis on the left. We performed transumbilical single-port laparoscopic bilateral high ligation of the hernia sacs (including both the direct and indirect components on the right) combined with reinforcement using the right medial umbilical ligament. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6-month follow-up, no recurrence, pain, or groin infection were observed, and the cosmetic outcome was excellent with minimal scarring. We believe that laparoscopy offers unique advantages in pediatric inguinal hernia repair by enabling accurate identification of "atypical" hernias, reducing missed diagnoses, and allowing contralateral exploration to decrease the risk of metachronous hernias, thereby minimizing unnecessary surgical and anesthetic risks as well as financial burden. We share our experience to provide an alternative therapeutic option.