Comparative Outcomes of Laparoscopic Inguinal Hernia Repair in Children: With or Without Peritoneal Dissection.

BACKGROUND: The necessity of routine peritoneal dissection during pediatric laparoscopic inguinal hernia repair remains uncertain. This study evaluated whether omitting peritoneal dissection affects recurrence, postoperative complications, or operative time after laparoscopic intracorporeal inguinal hernia repair in children. METHODS: In this multicenter retrospective cohort study, children younger than 8 years who underwent elective laparoscopic inguinal hernia repair at six tertiary centers in South Korea (January 2023-December 2024) were grouped according to whether peritoneal dissection was performed. Distal sac removal was analyzed as a subgroup procedure within the dissection group. All patients had 1-year follow-up, and propensity score matching was used to reduce baseline imbalance. RESULTS: Of 628 patients, 238 underwent repair without dissection and 390 with dissection. Operative time, recurrence, and overall complications did not differ significantly between groups (33 vs 32 minutes; 0.8% vs 0.5%; 2.1% vs 5.4%; all p>0.05), with similar results after matching. Distal sac removal was associated with longer operative time (75 vs 30 minutes, p<0.001) but not with higher complication or recurrence rates. CONCLUSION: Laparoscopic intracorporeal inguinal hernia repair without routine peritoneal dissection was not associated with worse outcomes. Distal sac removal prolonged operative time and should be reserved for selected cases. Prospective studies incorporating standardized anatomical measurements are warranted.