# Comparing Postoperative Outcomes Between Laparoscopic-Assisted Percutaneous Internal Ring Suturing and Laparoscopic Intracorporeal Internal Ring Suturing in the Management of Paediatric Inguinal Herniae: A Retrospective Review in Jordan

## TL;DR

This study compares two laparoscopic techniques for repairing inguinal hernias in children and finds both methods to be safe and effective with minimal complications.

## Contribution

The study provides a comparative analysis of LICS and LAPIRS in a pediatric population in Jordan, focusing on outcomes and cost.

## Key findings

- Both LICS and LAPIRS showed no intraoperative complications and minimal postoperative morbidity.
- Operative time and costs were comparable between the two techniques.
- No hernia recurrences or wound infections were observed after six months of follow-up.

## Abstract

Background: Congenital inguinal herniae are among the most common conditions requiring surgery in children. While laparoscopic repair offers diagnostic and cosmetic advantages over open repair, debate persists regarding the optimal method of internal ring closure. This study compares outcomes of laparoscopic intracorporeal internal ring suturing (LICS) and laparoscopic-assisted percutaneous internal ring suturing (LAPIRS) in a paediatric population.

Methods: We conducted a retrospective cohort study of children who underwent laparoscopic inguinal hernia repair at Jordan University Hospital between January 2019 and December 2020. Demographic data, clinical presentation, operative details, complications, costs, and follow-up outcomes were analysed. Patients undergoing concurrent orchidopexy were excluded.

Results: Of the 221 patients treated for inguinal herniae, 38 met the inclusion criteria (27 males, 11 females; mean age 3 years, range 45 days to 13 years). Seventeen patients (44.7%) underwent LAPIRS and 21 patients (55.3%) underwent LICS. No intraoperative complications occurred. Mean operative time was 45 minutes, with no significant difference between techniques or laterality (p = 0.849). Postoperative morbidity was minimal, with only one case of umbilical disfigurement following LAPIRS. No recurrences or wound infections were observed after a minimum of six months’ follow-up. The median cost was 512 Jordanian Dinars (JOD), equivalent to $720 US dollars, and was unaffected by technique (p = 0.395).

Conclusions: Both LICS and LAPIRS are safe, effective, and cosmetically favourable options for paediatric inguinal hernia repair. Outcomes were comparable, with negligible morbidity and no recurrences. Given potential differences in learning curve, cosmesis, and cost reported internationally, larger prospective studies with longer follow-up are warranted to refine best-practice recommendations.