Laparoscopic pediatric hernia repair closes an inguinal hernia in babies and children through the belly button and tiny openings, without mesh, and lets the surgeon check the other side and close it in the same anesthetic. In boys, the keyhole extraperitoneal method lowered the risk of a later hernia on the other side. At Biruni Hospital in Istanbul, our pediatric surgeons and anesthetists treat most children as day cases.
About This Department
Pediatric Surgery
An inguinal hernia in a child does not close on its own. Keyhole repair closes it through cuts of a few millimeters and checks the other side.
Laparoscopic pediatric hernia repair closes an inguinal hernia in a baby or child using a camera and fine instruments passed through the belly button and one or two tiny openings. The surgeon closes the open channel from the inside, sees whether the other side has the same opening, and closes both in one anesthetic if needed. Inguinal hernia repair is the most common operation in childhood (Morini and colleagues, European Journal of Pediatric Surgery, 2022). A meta-analysis of eight randomized trials found similar complication and recurrence rates for laparoscopic and open repair, with bilateral repair about seven minutes shorter by laparoscopy (Dreuning and colleagues, Surgical Endoscopy, 2019). In 17,555 boys, laparoscopic extraperitoneal repair lowered two risks. A later hernia on the other side and a testis rising out of the scrotum both became less frequent (Cheng and colleagues, Journal of Pediatric Surgery, 2023). This page explains signs, open and keyhole repair, the other side, boys and girls, premature babies, anesthesia, the day of surgery, recovery, and how families from abroad arrange the operation at Biruni Hospital in Istanbul.
83
Percent lower risk of a later hernia on the other side in boys after laparoscopic extraperitoneal repair
62
Percent lower risk of the testis rising out of the scrotum after laparoscopic extraperitoneal repair
7
Minutes saved on average when both sides are repaired laparoscopically
Free
Review of your child's records by our pediatric surgery team
A childhood inguinal hernia is an opening left behind from development before birth. It needs surgery, since it does not close by itself.
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The open channel
Before birth, a small pouch of the abdominal lining, the processus vaginalis, travels down the groin. It closes in most babies. When it stays open, bowel, fat or an ovary can slip into it as a bulge in the groin or scrotum.
Inguinal hernias appear more frequently in boys and in babies born early. The repair closes the top of the channel. Unlike adult hernias, the muscle wall is normal, and no mesh is used.
A small operation, a careful plan
The operation takes minutes. The planning around it matters.
Most children go home the same day, yet the timing of surgery, the anesthetic for a small baby, the choice between open and keyhole repair, the question of the other side and the arrangements for a family traveling from another country all need careful thought, and a pediatric surgeon, a pediatric anesthetist and nurses who work with children every day make each of those decisions together with the parents before the child arrives in the operating room.
Children differ from small adults.
Signs and emergencies
Signs of an inguinal hernia
Sign
What parents see
What to do
Groin or scrotal bulge
Appears with crying or straining, goes back at rest
Book a surgical review
Bulge that stays out
Firm, tender, does not go back
Emergency department
Vomiting with a hard bulge
Child unwell, irritable
Emergency department
Redness over the bulge
Skin discolored
Emergency department
A hernia that gets stuck, incarcerated, can trap bowel or an ovary and cut off its blood supply. Babies in their first months carry the highest risk. Repair is planned soon after diagnosis.
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Hernia or hydrocele
A hydrocele, fluid around the testis that passes through a very narrow channel, settles by itself in many babies by the age of one or two years, while a hernia always needs repair.
Laparoscopic or open repair
Both laparoscopic and open repair are safe, well-established operations in experienced hands.
Laparoscopic and open repair compared
Feature
Laparoscopic
Open
Incisions
Navel plus one or two of 2 to 3 millimeters
One groin cut of 1 to 2 centimeters
View of the other side
Seen directly
Not seen
Bilateral repair
Same small incisions, shorter time
Second groin cut
Handling of cord structures
Avoided in extraperitoneal methods
Sac separated from the cord
Recurrence
Similar in randomized trials
Similar
A meta-analysis of eight randomized trials with 733 children found no clear superiority of either approach, with similar complications and recurrences and a shorter operation when both sides were repaired laparoscopically (Dreuning and colleagues, 2019).
We recommend laparoscopic repair for most children, especially for bilateral hernias, recurrent hernias and girls, and discuss open repair when it suits the child better.
Keyhole techniques
All techniques close the opening at the top of the channel, from inside the abdomen or just outside its lining.
Two main approaches
Laparoscopic techniques for pediatric hernia
Technique
How it closes the opening
Note
Intracorporeal suturing
Stitch placed inside the abdomen with two instruments
Two extra small ports
Percutaneous extraperitoneal closure
Stitch passed around the opening under the skin with a needle, guided by the camera
Single port, almost no scar
Combined with hydrocele or other procedure
Same session
Planned in advance
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Our approach
For most children we use percutaneous extraperitoneal closure, which needs only the navel port and a needle puncture in the groin.
Findings by suturing method in the meta-analysis
Method
Advantage seen
Evidence
Extracorporeal suturing
Fewer complications, shorter unilateral operation
Subgroup analysis
Intracorporeal suturing
Shorter hospital stay
Subgroup analysis
The other side
Laparoscopic extraperitoneal versus open repair in 17,555 boys
Outcome
Risk ratio
Meaning
Later hernia on the other side
0.17
About 83 percent lower risk
Testis rising from the scrotum
0.38
About 62 percent lower risk
Hydrocele, testicular atrophy
No difference
Similar
Recurrence on the operated side
No difference
Similar
What we do when the other side is open
Contralateral findings during laparoscopy
Finding
Action
Reason
Wide open channel
Closed in the same anesthetic
Prevents a second operation
Narrow or closed channel
Left alone
Low risk
Hernia on both sides
Both repaired
Same incisions
Open repair cannot see the other side without a second groin cut. Laparoscopy shows it in seconds through the same camera (Cheng and colleagues, 2023).
Discussing it beforehand
We agree with parents in advance what to do if the other side is found open.
Watching the other side
A second hernia means a second anesthetic.
After open repair on one side, some children develop a hernia on the other side months or years later, and families then return for another operation, another fasting morning and another anesthetic for a young child. Seeing the other side through the laparoscope and closing a clearly open channel at the first operation spares many families that second visit, which matters even more when the family lives in another country.
Fewer operations, fewer worries.
Boys and the testis
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Protecting the cord
In boys, the vessels and the tube that carries sperm run next to the hernia sac. Extraperitoneal laparoscopic closure leaves them untouched, which may explain the lower rate of a testis rising out of the scrotum.
We check both testes before and after surgery. An undescended testis can be treated in the same anesthetic when planned.
Risks
Mild pain at the navel and groin for one to two days.
Small bruise or swelling in the groin or scrotum.
Temporary fluid in the scrotum, settling over weeks.
Uncommon complications
Complication
What happens
Management
Recurrence
Hernia returns
Second repair
Hydrocele
Fluid around the testis
Observation, sometimes drainage
Testis rising
Testis moves up
Orchidopexy
Wound infection
Redness at the navel
Antibiotics
Stitch reaction
Small lump at the needle site
Settles
Serious complications are rare. The main risks of the day relate to anesthesia in very small babies, managed by pediatric anesthetists.
Recurrence
Recurrence rates were similar for laparoscopic and open repair in the randomized trials.
Girls and the ovary
My daughter has a lump in the groin. Is it different for girls?
In girls, the ovary can slip into the hernia and be felt as a small firm lump. An ovary that cannot be pushed back needs prompt surgery, since its blood supply can twist. Laparoscopy is particularly useful in girls, showing the ovary and both sides, and the European guideline found the evidence on how quickly to operate on an irreducible ovary insufficient, so we operate within days or sooner if there is pain (Morini and colleagues, 2022).
Laparoscopy also confirms normal internal anatomy in girls, which matters in rare cases of differences of sex development discovered at hernia repair.
Premature babies
European guideline findings for premature babies
Question
Finding
Practice
Repair before or after leaving neonatal care
After discharge linked with fewer breathing problems and recurrences
Plan timing with the neonatal team
Anesthesia
Regional anesthesia linked with less apnea and pain
Spinal or caudal block where suitable
Monitoring
Apnea risk after anesthesia
Overnight monitoring in young preterm babies
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Overnight stay
Babies born early and still under about 60 weeks after conception stay overnight on breathing monitors after any anesthetic.
Timing of repair
Child
Timing
Reason
Term baby
Soon after diagnosis
Incarceration risk
Preterm baby in neonatal care
After discharge in many cases
Fewer breathing problems
Older child
Planned
Low urgency unless stuck
Every premature baby is assessed with the neonatal team. Our pediatric intensive care unit supports babies who need closer monitoring.
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Our pediatric ICU
Our pediatric intensive care page describes how we care for children who need close monitoring after surgery.
The day of surgery
Fasting before anesthesia for children
Intake
Stop before anesthesia
Note
Solid food and formula
Six hours
Light meal the evening before
Breast milk
Four hours
Babies
Clear fluids
One hour
Water, clear apple juice
Timeline
A typical day
Step
Timing
Note
Arrival and checks
Morning
Weight, temperature, numbing cream
Anesthesia
Parent present at induction
Mask or drip
Surgery
20 to 40 minutes
Longer if both sides
Recovery
One to two hours
Parent at the bedside
Discharge
Same afternoon
Overnight for young preterm babies
A parent stays with the child until asleep and is called back as soon as recovery begins. Local anesthetic placed during surgery keeps pain low on waking.
Recovery at home
Most children are playing normally within one or two days, and many are running around the hotel room by the evening of surgery, to the surprise of their parents.
Paracetamol or ibuprofen for a day or two is enough for most children, and the tiny wounds, covered with glue or strips, need no stitch removal.
Bathing and activity
Showers from the next day and baths after three days. Nursery and school after two to three days, and sports, bicycles and climbing after two weeks.
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Call us if
The bulge returns, the scrotum swells and hurts, a wound turns red, or your child has fever or repeated vomiting.
Parents at the bedside
Children recover best with their parents close.
A parent stays with the child at induction, in the recovery room and through discharge, and on overnight stays sleeps in the room.
Bring a favorite toy.
For families from abroad
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Length of stay
Plan for three to four days in Istanbul, the consultation and surgery on the first or second day and a wound check before the flight home. Children are fit to fly two to three days after surgery.
Send a photograph or video of the bulge, the age and birth history of your child, any ultrasound and details of other health conditions.
After you return home, follow-up continues by video at one week and three months. One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Cost
The price depends on one or both sides, the age of the child and any overnight stay.
We quote after reviewing your child's records, before you travel. Compare quotes for the same technique, and ask whether pediatric anesthesia and the check of the other side are included.
What a quote for laparoscopic hernia repair covers
Item
Included
Priced separately
Surgery
Pediatric surgeon, laparoscopic equipment
Other procedures in the same session
Anesthesia
Pediatric anesthetist
Overnight monitoring for preterm babies
Aftercare
Medicines, wound check, video follow-up
Further visits
Elements that change the price
What changes the price
Element
Effect
Note
Both sides repaired
Slightly higher
Same incisions
Premature baby
Higher
Overnight monitoring
Undescended testis or hydrocele
Higher
Combined surgery
References
Dreuning K, Maat S, Twisk J, van Heurn E, Derikx J. Laparoscopic versus open pediatric inguinal hernia repair, a meta-analysis. Surg Endosc. 2019;33(10):3177-3191.
Morini F, Dreuning KMA, Janssen Lok MJH, et al. Surgical management of pediatric inguinal hernia. A systematic review and guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee. Eur J Pediatr Surg. 2022;32(3):219-232.
Cheng PL, Duh YC, Chen JJ, Huang FH. Laparoscopic extraperitoneal hernia repair versus open repair in boys with inguinal hernia. A meta-analysis. J Pediatr Surg. 2023;58(7):1322-1331.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Dr. Hasret AYYILDIZ CİVAN, Pediatric Gastroenterology.
