Laparoscopic inguinal sac resection (LISAR): A multicenter retrospective case series over two decades in pediatric hernia repair.

BACKGROUND

Laparoscopic pediatric inguinal hernia repair is commonly performed with internal ring ligation (e.g., PIRS/LPEC). Laparoscopic Inguinal Sac Resection (LISAR) excises the sac at its origin without routine ring closure, mirroring the open principle of complete sac resection. We evaluated long-term outcomes of LISAR across two decades.

METHODS

Retrospective multicenter case series of consecutive patients aged 1 month-18 years who underwent LISAR for indirect inguinal hernia (January 2003-December 2024) at three tertiary centers. Prespecified descriptors: sex, adolescent subgroup (12-18 years), laterality, concurrent orchidopexy, and internal ring closure.

PRIMARY OUTCOMES: recurrence, early postoperative complications (≤30 days), urologic sequelae, and conversion to open surgery.

SECONDARY OUTCOMES: total operative time, and long-term follow-up.

RESULTS

1203 patients (1424 repairs) underwent LISAR: 1009 males (83.9 %), 194 females; 221 bilateral (18.4 %); 142 adolescents (11.8 %). Concurrent orchidopexy was performed in 62 (5.2 %). Internal ring closure was selective (55/1203; 4.6 %). Mean operative time (pooled) was 26.0 min. There were no conversions (0/1203). Early complications occurred in 2/1203. Urologic sequelae were 0/1009. Recurrence was 0.58 % per patient (7/1203) and 0.49 % per repair (7/1424); all recurrences occurred in non-closure cases. Long-term follow-up (≥30 days) was documented for 100 % of patients; cohort-weighted mean duration was 57.3 months. In adolescents, there were no recurrences, conversions, or early complications (0/142).

CONCLUSIONS

Over 22 years in three centers, LISAR achieved low recurrence, no conversions, and minimal morbidity. A standardized sac-resection approach without routine ring closure appears safe and effective in children and adolescents.