# Laparoscopic disconnection of the hernial sac: is it enough for the treatment of congenital inguinal hernia in children?

## TL;DR

This study compares two laparoscopic techniques for treating congenital inguinal hernias in children, finding that one method is sufficient for smaller hernias while another is better for larger ones.

## Contribution

The study introduces an IRD-based algorithm to optimize laparoscopic hernia repair in children by comparing sac disconnection alone versus combined repair.

## Key findings

- No hernia recurrences were observed in either group during one-year follow-up.
- Laparoscopic sac disconnection alone is sufficient for internal ring diameter ≤ 1 cm with shorter operative times.
- IPTR is recommended for larger defects (> 1 cm) to ensure durable repair despite longer operative times.

## Abstract

Laparoscopic repair of congenital inguinal hernia (CIH) has evolved with various techniques. Some advocate for sac disconnection alone, while others emphasize additional peritoneal closure or internal ring narrowing to prevent recurrence. This study evaluates the efficacy of laparoscopic sac disconnection alone versus disconnection with iliopubic tract repair (IPTR) for CIH, stratified by internal ring diameter (IRD), analyzing recurrence rates and postoperative complications.

This study (April 2021- December 2023) included 208 children with CIH in the age range from 3 months to 12 years. Patients were stratified by IRD: Group A (≤ 1 cm, n = 142) underwent sac disconnection alone; Group B (> 1 cm, n = 66) received additional IPTR. Outcomes assessed included recurrence rates, operative time, and postoperative complications.

No hernia recurrences were observed in either group during the one-year follow-up. Group A had significantly shorter operative times (mean: 21.17 ± 5.42 min for unilateral cases) compared to Group B (37.61 ± 5.79 min). Postoperative scrotal edema occurred in 1.4% of Group A patients and 12.1% of Group B patients, but all cases were resolved spontaneously. No intraoperative injuries to the vas deferens or testicular vessels were reported.

Laparoscopic sac disconnection alone is sufficient for CIH with IRD ≤ 1 cm, offering shorter operative times with excellent outcomes. For larger defects (> 1 cm), IPTR provides durable repair despite longer operative times. This IRD-based algorithm optimizes outcomes while maintaining procedural simplicity.

The online version contains supplementary material available at 10.1007/s10029-025-03471-z.