Mechanisms of recurrence after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia: a single-center video review study.

BACKGROUND

Laparoscopic assisted percutaneous extraperitoneal closure (LPEC) is widely used in Japan for pediatric inguinal hernia repair and associated with a low recurrence rate. This study aimed to investigate recurrent cases to determine possible causes.

METHODS

This study retrospectively reviewed patients who underwent reoperation for ipsilateral recurrence after the initial LPEC performed at our institution between 2009 and 2024. Recurrence was confirmed through 2025. Medical records and operative videos were analyzed to evaluate patient characteristics, interval to recurrence, operative findings, recurrence patterns, and reoperative procedures. Recurrence rates were also compared based on the suture material.

RESULTS

In 1,894 patients, 11 recurrences (0.58%) occurred. No significant differences in age, sex, or side were observed. The median interval to recurrence was 32 months. The video review identified one technical error involving needle deviation into the muscle layer. Two cases were de novo-type recurrences. In nine cases, a central pinhole in the ligation ring suggested ligature loosening. Recurrence rates were lower with polyester sutures than with silk (0.16% vs. 0.79%), though not statistically significant (p = 0.28).

CONCLUSIONS

LPEC demonstrated a low recurrence rate. Most recurrences were associated with inadequate ligation, and recurrence rates tended to be lower with polyester sutures.