Assessment of postoperative outcomes of LAT-HSL in the treatment of unilateral inguinal hernia in boys: A multicenter prospective randomized controlled study.

BACKGROUND: Single-port laparoscopic hernia needle extraperitoneal high ligation of the hernia sac (LH) has been widely adopted for indirect inguinal hernia due to its concealed surgical incision and rapid postoperative recovery. Laparoscope-Assisted Trans-scrotal Hernia Sac ligation (LAT-HSL) is an alternative surgical approach for high ligation of the indirect inguinal hernia sac performed via a scrotal approach under laparoscopic assistance. However, head-to-head comparative data on the clinical outcomes of LAT-HSL versus LH for pediatric inguinal hernia remains limited.

OBJECTIVE: To Comparing the efficacy, safety and economic outcomes of the LAT-HSL and LH procedures in the treatment of unilateral indirect inguinal hernia in boys aged 1-3 years.

METHODS: This multicenter, single-blnd, prospective randomized controlled trial was conducted at the pediatric surgery departments of two tertiary children's medical centers in China. Male pediatric patients aged 1-3 years with primary unilateral indirect inguinal hernia (confirmed by abdominal ultrasonography) admitted between April 2024 and June 2025 were enrolled, with a total of 104 patients included in the final analysis. Eligible patients were randomly allocated to either the LH group (n = 53) or the LAT-HSL group (n = 51), with a 6-month postoperative follow-up period. The primary outcomes were postoperative hernia recurrence rate and overall complication rate within 6 months of surgery. Secondary outcomes included intraoperative parameters (pneumoperitoneum duration, operative time, mean end-tidal carbon dioxide [ETCO2], and incidence of intraoperative hypocapnia [ETCO2 < 35 mmHg]), postoperative recovery indicators (length of hospital stay, Face, Legs, Activity, Cry, Consolability [FLACC] pain scores at 12 and 24 h postoperatively, and Manchester Scar Scale (MSS) scores at 1 week, 2 weeks, and 1 month postoperatively), and medical costs. Normally distributed continuous data were expressed as mean ± standard deviation and compared using the t-test. Non-normally distributed continuous data were presented as median (interquartile range [IQR]) and compared using the Mann-Whitney U test. Categorical variables were analyzed using Pearson's chi-square test and Fisher's exact test. Univariate and multivariate regression models were employed to identify independent factors associated with intraoperative parameters.

RESULTS: A total of 104 patients were included in the study, with 53 cases (20.0 [16.0,31.5] months])in the LH group and 51 cases (16.0 [12.0,23.0] months) in the LAT-HSL group. Compared to the LH group, the LAT-HSL group had significantly longer operative time (30.0 [24.0,42.0] min vs 24.0 [18.0,30.0] min, P = 0.001) and hospital stay (1.0 [1.0,2.0] days, 1.0 [1.0,1.0] days, P = 0.003). While, LAT-HSL group had significantly shorter pneumoperitoneum time (1.5 [1.0,2.5] min vs 24.0 [18.0,30.0] min, P < 0.001) and smaller proportion of normal-low ETCO2 values (2 cases [3.9%] vs 12 cases [22.6%], P = 0.005). At Jiaxing University Affiliated Jiaxing Women and Children Hospital where disposable hernia needles are utilized, the consumable cost in the LAT-HSL group was significantly lower than that in the LH group (1569.1 [1569.1,1569.1]CNY vs 1168.5 [1078.8,1569.3]CNY, P = 0.001).

CONCLUSION: LAT-HSL and LH have comparable short-term safety and efficacy for the treatment of unilateral indirect inguinal hernia in boys aged 1-3 years. LAT-HSL is associated with a significantly shorter pneumoperitoneum duration and lower risk of intraoperative hypocapnia, and may reduce medical consumable costs in centers using disposable laparoscopic hernia needles. Therefore, LAT-HSL represents a safe, effective, and economical surgical option for this patient population.