Laparoscopic Repair of Primary Hiatal Hernia in Children: Systematic Review of Surgical Techniques and Outcomes.

OBJECTIVE: This systematic review analyzed laparoscopic repair of primary hiatal hernia (HH) in children, focusing on presentation, diagnosis, surgical techniques and postoperative outcomes. METHODS: Studies published between 2000 and 2025 on laparoscopic repair of primary pediatric HH were identified according to PRISMA guidelines (PROSPERO: CRD420261295203). Due to heterogeneity in study design and outcome reporting, a meta-analysis was not feasible. Data were summarized descriptively. Selected comparisons used Fisher's exact test and odds ratios (ORs) with 95% confidence intervals (CIs)(p < 0.05) Results: Twenty-seven studies reporting 353 patients met the inclusion criteria. The evidence was of low certainty, consisting predominantly of case reports (n=12) and case series (n=10), with only five retrospective cohorts and no prospective studies. Estimated median age was 18.6 months (range 6 days-16 years). Gastroesophageal reflux disease was the most common symptom. Laparoscopic repair was performed in all patients, with 1.4% conversion rate and one intraoperative complication. Recurrence occurred in 21/331 (6.3%). Patch-reinforced repair showed a non-significantly higher recurrence rate than primary repair (OR 2.63, 95% CI 0.54-12.8; p=0.24). Esophageal stenosis was the most frequent postoperative complication (n=40/331; 12.1%) and was more common after Nissen-Rossetti than Thal fundoplication (OR 2.63, 95% CI 1.11-6.25; p=0.027), although heterogenous reporting and missing data limit this comparison. CONCLUSION: Laparoscopic repair of primary pediatric HH appears feasible, with low reported perioperative morbidity and acceptable recurrence rates, but evidence is low certainty. Fundoplication appears reasonable but the observed association of complete wraps with stenosis requires cautious interpretation.. Current evidence does not support routine patch reinforcement.