Can One-port Laparoscopic Percutaneous Internal Ring Suturing Technique be an Alternative to Conventional Laparoscopic Repair for Female Inguinal Hernia? - A Nonrandomized Comparative Cohort Study.

BACKGROUND: The optimal laparoscopic technique for pediatric female inguinal hernia remains debated. While intracorporeal Incision, Dissection, Excision, and Suturing (IDES) closely emulates open herniotomy, Percutaneous Internal Ring Suturing (PIRS) offers a simpler, one-port alternative. This study compares the feasibility, safety, and long-term efficacy of PIRS versus conventional IDES in female children. MATERIALS AND METHODS: In this single-center case-control study conducted over 10 years, 178 female children (1-12 years) undergoing elective laparoscopic inguinal hernia repair were included. Ninety-three patients underwent IDES repair, and 85 underwent one-port PIRS. Perioperative parameters, intraoperative events, postoperative recovery, and long-term recurrence were analyzed. Patients were followed up at regular intervals for a mean duration of approximately 9 years. Statistical analysis included fragility index assessment for significant outcomes. RESULTS: Baseline characteristics were comparable between groups. The mean operative time was significantly shorter in the PIRS group (P < 0.001). Detection and repair rates of contralateral patent processus vaginalis were similar (~15%). Postoperative pain scores, analgesic requirements, time to oral feeds, hospital stay, and early complications were comparable. One recurrence occurred in each group during long-term follow-up, with no statistically significant difference. Suture breakage and minor subperitoneal hematoma were infrequent and statistically fragile findings without clinical consequence. No major vascular injuries or long-term morbidity were observed. CONCLUSION: One-port PIRS provides outcomes equivalent to conventional laparoscopic IDES repair in female pediatric inguinal hernia, with the advantage of reduced operative time and technical simplicity. In experienced hands, PIRS represents a safe, durable, and cosmetically superior alternative suitable for routine use in girls.