# The application of single-hole laparoscopic repair with slow-absorbable suture in the treatment of indirect inguinal hernia in children

## TL;DR

This study compares slow-absorbable and non-absorbable sutures in children's hernia surgery, finding similar recurrence rates but fewer suture reactions with the absorbable option.

## Contribution

Demonstrates that slow-absorbable sutures (PDS) are as effective as non-absorbable ones (MERSILK) for pediatric hernia repair, with fewer complications.

## Key findings

- Recurrence rates were not significantly different between slow-absorbable and non-absorbable suture groups.
- Non-absorbable sutures had a significantly higher incidence of suture knot reactions.
- Patient age and internal ring diameter were significant independent risk factors for recurrence.

## Abstract

The choice of suture material for laparoscopic high ligation of pediatric indirect inguinal hernia remains debated. While non-absorbable sutures are traditionally preferred to minimize recurrence, they pose potential long-term risks as permanent foreign bodies, including suture reaction and theoretical oncogenic concerns. Recent expert consensus suggests absorbable sutures may be a viable alternative, though comparative evidence, particularly for slow-absorbable variants, is limited.

This study aimed to compare the surgical outcomes, specifically recurrence rates and suture-related complications, between slow-absorbable (Polydioxanone, PDS) and non-absorbable (MERSILK) sutures in single-port laparoscopic indirect inguinal hernia repair in children.

A retrospective analysis was conducted on 1022 children with unilateral indirect inguinal hernia who underwent surgery at our center between October 2022 and October 2023. Patients were divided into two groups based on the suture material used: a slow-absorbable suture group (n = 663) and a non-absorbable suture group (n = 359). Patient demographics, operative details, and postoperative complications (recurrence and suture knot reaction) were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for recurrence.

The recurrence rate was 2.0% (13/663) in the slow-absorbable suture group and 0.8% (3/359) in the non-absorbable suture group; this difference was not statistically significant (P = 0.197). Multivariate analysis confirmed that suture type was not an independent risk factor for recurrence [OR = 1.898, 95% CI: 0.475–7.583, P = 0.365]. In contrast, a statistically significant higher incidence of suture knot reaction was observed in the non-absorbable group (0.8% vs. 0%, P = 0.043). Patient age and the internal ring diameter of theprocessus vaginalis were identified as significant independent risk factors for recurrence (P < 0.001 and P = 0.001, respectively).

The use of slow-absorbable sutures (PDS) for laparoscopic indirect inguinal hernia repair in children does not significantly increase recurrence rates compared to non-absorbable sutures (MERSILK), while effectively eliminating the risk of suture knot reactions. Recurrence is primarily determined by patient age and internal ring diameter, not suture absorbability. Slow-absorbable sutures present a safe and effective alternative, alleviating long-term foreign body concerns without compromising surgical success.