Can One-port Laparoscopic Percutaneous Internal Ring Suturing Technique be an Alternative to Conventional...

The optimal laparoscopic technique for pediatric female inguinal hernia remains debated. While intracorporeal Incision, Dissection, Excision, and Suturing (IDES) closely emulates open herniotomy, Percutaneous Internal Ring Suturing (PIRS) offers a simpler, one-port alternative. This study compares the feasibility, safety, and long-term efficacy of PIRS versus conventional IDES in female children.

In this single-center case-control study conducted over 10 years, 178 female children (1-12 years) undergoing elective laparoscopic inguinal hernia repair were included. Ninety-three patients underwent IDES repair, and 85 underwent one-port PIRS. Perioperative parameters, intraoperative events, postoperative recovery, and long-term recurrence were analyzed. Patients were followed up at regular intervals for a mean duration of approximately 9 years. Statistical analysis included fragility index assessment for significant outcomes.

Baseline characteristics were comparable between groups. The mean operative time was significantly shorter in the PIRS group (P < 0.001). Detection and repair rates of contralateral patent processus vaginalis were similar (~15%). Postoperative pain scores, analgesic requirements, time to oral feeds, hospital stay, and early complications were comparable. One recurrence occurred in each group during long-term follow-up, with no statistically significant difference. Suture breakage and minor subperitoneal hematoma were infrequent and statistically fragile findings without clinical consequence. No major vascular injuries or long-term morbidity were observed.

One-port PIRS provides outcomes equivalent to conventional laparoscopic IDES repair in female pediatric inguinal hernia, with the advantage of reduced operative time and technical simplicity. In experienced hands, PIRS represents a safe, durable, and cosmetically superior alternative suitable for routine use in girls.