Clinical Report: Laparoscopic Sac Disconnection for Pediatric Congenital Inguinal Hernia

Overview

This study evaluated laparoscopic disconnection of the hernial sac without peritoneal closure in children with congenital inguinal hernia (CIH). Patients with an internal ring diameter (IRD) ≤1 cm underwent sac disconnection alone, while those with IRD >1 cm received additional iliopubic tract repair (IPTR). The approach demonstrated safety, efficacy, and low recurrence rates within one year.

Background

Congenital inguinal hernia (CIH) is commonly treated surgically, with laparoscopic repair emerging as a minimally invasive alternative to open surgery since the 1990s. Various laparoscopic techniques exist, including sac ligation without disconnection, sac disconnection with peritoneal closure, and complete sac resection with selective ring repair. However, no consensus exists on the optimal technique. This study aimed to assess whether sac disconnection alone, without peritoneal closure, is sufficient for CIH repair in pediatric patients.

Data Highlights

Key Findings

• Laparoscopic sac disconnection without peritoneal closure is effective for CIH with IRD ≤1 cm.
• For IRD >1 cm, adding iliopubic tract repair (IPTR) provides adequate ring narrowing without peritoneal closure.
• The technique avoids peritoneal closure, simplifying the procedure and potentially reducing operative time.
• Recurrence rates within one year were low in both groups, indicating durable repair.
• Postoperative complications were minimal, supporting the safety of this approach.
• Measurement of the internal ring diameter intraoperatively guides the choice of repair technique.

Clinical Implications

Surgeons can consider laparoscopic sac disconnection without peritoneal closure as a sufficient repair for pediatric CIH when the internal ring diameter is ≤1 cm. For larger rings (>1 cm), adding iliopubic tract repair effectively narrows the ring without the need for peritoneal closure, potentially simplifying surgery and maintaining low recurrence rates. This approach may reduce operative complexity and improve recovery.

Conclusion

Laparoscopic sac disconnection alone is a safe and effective technique for treating congenital inguinal hernia in children with small internal ring diameters, while selective iliopubic tract repair for larger rings maintains excellent outcomes without peritoneal closure. This strategy offers a simplified, minimally invasive option with low recurrence and complication rates.

References

1. Becmeur et al. 2010 -- Laparoscopic disconnection of the hernial sac with closure
2. Riquelme et al. 2015 -- Complete disconnection and resection of hernial sac
3. Patkowski 2006 -- PIRS Technique for laparoscopic hernia repair
4. Montupet 1990s -- Purse-string suture technique
5. Schier 2006 -- N-shaped suture technique
6. Burnia 2010 -- Cauterization around internal ring