Laparoscopic iliopubic tract repair for adolescent inguinal hernia: a large-scale cohort study of 433 cases demonstrating a safe, mesh-free technique.

PURPOSE: The optimal surgical strategy for adolescent inguinal hernia remains controversial because this population lies between pediatric and adult hernia pathology. Pediatric high ligation may be insufficient in adolescents with posterior wall weakness, while routine mesh repair raises concerns regarding chronic pain and long-term foreign-body complications. Laparoscopic iliopubic tract repair (IPTR) offers a mesh-free posterior wall reinforcement strategy specifically suited to adolescent anatomy.

METHODS

This retrospective cohort study included 433 adolescents aged 10–19 years who underwent laparoscopic IPTR for indirect inguinal hernia between January 2014 and December 2023. Operative outcomes, postoperative complications, chronic inguinodynia, and recurrence rates were analyzed.

RESULTS

The mean age at surgery was 13.2 ± 2.9 years, and 75.3% of patients were male. Most hernias were unilateral (97.2%), with inguinal hernias at 86.8% and inguinoscrotal hernias at 13.2%. All procedures were completed laparoscopically without conversion. The mean operative time was 16.8 ± 2.9 min for unilateral repair and 28.8 ± 5.8 min for bilateral repair. Postoperative complications were rare (0.7%), including hematoma and seroma. During a mean follow-up of 67.6 ± 34.0 months, four patients (0.9%) required reoperation for chronic pain, metachronous contralateral hernia, or recurrence. Hernia recurrence occurred in two patients (0.5%), both within the first postoperative year; all recurrences were successfully managed laparoscopically.

CONCLUSIONS

Laparoscopic IPTR is a safe, durable mesh-free technique for adolescent inguinal hernia repair, with low morbidity and excellent long-term recurrence rates. This approach may serve as a reliable surgical bridge between pediatric high ligation and adult mesh repair in adolescents.