Laparoscopic Pediatric Hernia Repair
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
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.
What a hernia in a child is
A childhood inguinal hernia is an opening left behind from development before birth. It needs surgery, since it does not close by itself.
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
| 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 |
Laparoscopic or open repair
Both laparoscopic and open repair are safe, well-established operations in experienced hands.
| 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).
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
| 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 |
| Method | Advantage seen | Evidence |
|---|---|---|
| Extracorporeal suturing | Fewer complications, shorter unilateral operation | Subgroup analysis |
| Intracorporeal suturing | Shorter hospital stay | Subgroup analysis |
The other side
| 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
| 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 |
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
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.
| 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?
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 |
| 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 |
The day of surgery
| 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
| 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 |
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.
Bathing and activity
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
Send a photograph or video of the bulge, the age and birth history of your child, any ultrasound and details of other health conditions.
Cost
The price depends on one or both sides, the age of the child and any overnight stay.
| 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
| 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 Assistant Professor Yıldırım Mehmet RAMAZANOĞLU, Pediatrics and Neurology.
Medically reviewed by
Assistant Professor Yıldırım Mehmet RAMAZANOĞLU
Pediatrics and Neurology
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