Rare findings of indirect inguinal hernia repair during laparoscopic PIRS technique in children: a two-center audit.

Introduction: This study aimed to present rare findings encountered during laparoscopic inguinal hernia repair in children. Methods: The study included children who underwent laparoscopic surgery for inguinal hernia (IH). The focus was on unexpected intraoperative findings other than a typical inguinal hernia. These included direct and femoral hernias, various hernia variants, and other unusual presentations. Results: A total of 790 children were included in the study. Unexpected laparoscopic findings were observed in 22 cases. The mean age of the patients was 33 months (range: 1-168 months), and the mean weight was 12.5 kg (range: 2-46 kg). Direct hernias were identified in seven children. Four children had an incarcerated appendix within the hernia sac, one of whom required an appendectomy. Omental incarceration was noted in three children, and no hernia was found in two cases. Additionally, single cases of femoral hernia, Spigelian hernia, pantaloon hernia, intraabdominal spermatic cord cyst, suspicious gonadal structure, and incarcerated uterus with ovary was observed. Direct inguinal hernia was identified in seven children; four were repaired laparoscopically, whereas three underwent open repair. No intraoperative or postoperative complications were reported. Conclusions: The advantages provided by the laparoscopic approach include comprehensive visualization of the intraabdominal cavity allowing for prompt identification and safer management of rare or atypical findings.