# Comparative Effectiveness of Pediatric Laparoscopic and Laparoscopically Assisted Inguinal Hernia Repairs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study compares two minimally invasive hernia repair methods in children and finds they are similarly safe and effective, with differences in surgical time and cosmetic outcomes.

## Contribution

The study provides a systematic review and meta-analysis comparing laparoscopic and laparoscopically assisted hernia repair in children.

## Key findings

- Both LIHR and LAIHR showed similar recurrence rates and complication profiles in pediatric patients.
- Operative time varied significantly and was influenced by surgical factors rather than procedure type.
- LAIHR showed slightly better early recovery and cosmetic outcomes in some studies.

## Abstract

Among children, surgical procedures most often done include inguinal hernia repair. Although both laparoscopically assisted inguinal hernia repair (LAIHR) and laparoscopic inguinal hernia repair (LIHR) are rather common minimally invasive methods, their relative safety, efficacy, and outcomes are still questionable. This systematic review and meta-analysis sought to examine the efficacy and complication profiles of LIHR and LAIHR in children derived from data from randomized controlled trials. Through March 2025, PubMed, Embase, Scopus, Web of Science, and CENTRAL were searched systematically to find randomized controlled trials comparing LIHR and LAIHR in pediatric patients. Included were studies reporting on hernia recurrence, operative duration, transient hydrocele, wound complications, and recovery outcomes. Random-effects models were used to conduct meta-analyses. Using the American Society of Plastic Surgeons (ASPS) grading scheme for prognostic or risk studies, the degree of evidence and strength of suggestions were evaluated. Sixteen trials with a total of 1,402 pediatric patients were included. Pooled findings showed no statistically significant variation in hernia recurrence rates between LIHR (1.9%; 95% CI: 0-3%) and LAIHR (0.7%; 95% CI: 0-2%) (P = 0.052; I² = 29%). Likewise, no statistically significant differences were found in the rates of transient hydrocele (P = 0.1379) or wound infection (P = 0.4951). Analysis of operative time revealed extreme statistical heterogeneity (I² = 100%), precluding a meaningful pooled comparison. This indicates that operative duration is highly variable and dependent on unmeasured, center-specific factors such as surgical technique and experience, rather than representing a consistent difference between the two broad procedure categories. Both strategies showed outstanding safety profiles and low complication rates. Early recovery results and cosmetic satisfaction were somewhat more positive with LAIHR in some studies. Both LIHR and LAIHR are effective, safe, and cosmetically acceptable ways to repair pediatric inguinal hernia, with no major variances in recurrence or most complication rates. Operative time is not a distinguishing feature between the techniques but is instead highly context-dependent. LAIHR may have benefits in chosen contexts for surgical time and aesthetic results. The method chosen should fit patient's needs, surgical proficiency, and hospital's assets.