Single port laparoscopic umbilical fold reinforcement surgery reduces the postoperative recurrence rate of pediatric giant inguinal hernia.

This is a retrospective clinical study that summarizes the clinical experience of single-port laparoscopic medial umbilical fold reinforcement surgery (SPLMUFRS) for pediatric giant inguinal hernia with the internal ring diameter greater than 1.5 centimeters. 147 children with inguinal hernia admitted to the Department of Pediatric Surgery, Qilu Hospital of Shandong University (Qingdao) from July 2019 to June 2023 were included in this study, including 124 males and 23 females. All patients were divided into Group A (n = 86) and Group B (n = 61) based on the last digit of their hospitalization number, with odd numbers included in Group A and even in Group B. Both groups underwent single-port laparoscopy, but the surgical methods were different. The primary outcome was the postoperative recurrence rate, and secondary outcomes were the percentage of metachronous indirect inguinal hernia (MCIH), surgical time, and pain score at hernia needle puncture site. The average age of Group A was 61.5 ± 23.8 (13-148) months, and the average weight was 22 (18-27) Kg. The average age of Group B was 57.7 ± 27.2 (17-159) months, and the average weight was 22 (19-27) Kg. There was no statistically significant difference in age and weight between the two groups. During the laparoscopy, a total of 147 unclosed internal rings were found that had a diameter greater than 1.5 cm (86 in Group A and 61 in Group B), and they were treated with SPLMUFRS after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC), with Group A underwent V-shaped fixation method and Group B underwent U-shaped fixation method. The average surgical time for Group A was 11.8 ± 1.9 (9-16) minutes, while Group B was 13.8 ± 2.6 (9-20) minutes, and the difference in surgical time between the two groups was statistically significant (P<0.001). All patients underwent surgery smoothly. All patients were followed up for 1-3 years after surgery, and no patients experienced postoperative recurrence. Several patients experienced short-term pain at the puncture site or temporary hydrocele, which improved significantly after conservative observation. Although there are differences in the surgical methods and surgical time between the two types of SPLMUFRS, they are safe and reliable for pediatric giant inguinal hernia with the internal ring diameter greater than 1.5 cm, and can reduce the postoperative recurrence rate.