Percutaneous internal ring suturing versus conventional laparoscopic repair of congenital inguinal hernia: a randomized controlled trial.

Summary

In a randomized pediatric trial (n=109), PIRS achieved markedly shorter unilateral operative time, lower spermatic cord edema, comparable recurrence, and higher parental scar satisfaction versus conventional laparoscopic repair. Findings support PIRS as a minimally invasive option with superior perioperative efficiency and cosmetic outcomes.

Key Findings

• Unilateral operative time significantly shorter with PIRS: 8.5 ± 3.9 min vs 40.8 ± 9.9 min (p < 0.001).
• Lower postoperative spermatic cord edema with PIRS: 1.9% vs 19.6% (p < 0.05).
• Recurrence numerically lower with PIRS (1.9% vs 5.4%; p > 0.05) and higher parental scar satisfaction (p < 0.05).

Clinical Implications

PIRS can be preferentially considered for pediatric inguinal hernia repair to reduce operative time and edema while improving scar satisfaction, pending longer-term recurrence data.

Limitations

• Single-sex cohort (male only) with modest sample size.
• Short follow-up with limited power to detect differences in long-term recurrence; lack of blinding inherent to surgical trials.

Future Directions

Multicenter RCTs with longer follow-up, inclusion of females, cost-effectiveness analyses, and standardized cosmetic outcome measures.