Age-stratified outcomes after laparoscopic inguinal hernia repair in children: A large single-center cohort study.

BACKGROUND

Age-related differences in presentation and outcomes after laparoscopic inguinal hernia repair (LIHR) remain incompletely characterized. We evaluated age-stratified perioperative characteristics and recurrence after LIHR.

METHODS

We conducted a retrospective single-center cohort study of consecutive children undergoing LIHR, stratified as <6 months, 6-12 months, 1-2 years, 2-5 years, and >5 years. The primary outcome was recurrence, while secondary outcomes included incarceration, hernia laterality, operative time, occult contralateral hernia detection, conversion to open surgery, complications, and length of stay.

RESULTS

Among 8941 children, incarceration occurred in 2.1%, bilateral hernia in 47.6%, and occult contralateral hernia was detected in 39.2%. Incarceration decreased with age (15.6% in <6 months vs 0.6-0.7% in >2 years; P < 0.001), and bilateral hernia was most frequent in <6 months (74.6%; P < 0.001). Median operative time decreased from 31 min (<6 months) to 26 min (>5 years; P < 0.001). Occult contralateral hernia was most common in <6 months (52.7%; P < 0.001). Conversion was highest in <6 months (0.8%) and absent in >5 years (P = 0.009). Recurrence was 1.3% (113/8941), with none in <6 months and increasing to 2.1% in >5 years (P < 0.001). Male sex (HR 2.974, 95% CI 1.708-5.176) and unilateral presentation (HR 5.141, 95% CI 2.931-9.017) independently predicted recurrence.

CONCLUSIONS

Infants, especially those <6 months, had higher rates of incarceration and bilateral disease, more frequent occult contralateral findings, and greater operative complexity. Recurrence after LIHR was low overall, absent in <6 months, and increased with age, supporting age-stratified counseling, operative planning, and follow-up.