Adding iliopubic tract repair to high ligation reduces recurrence risk in pediatric laparoscopic transabdominal inguinal hernia repair



Many laparoscopic methods are available for treating pediatric inguinal hernias. Recurrence after laparoscopic pediatric inguinal hernia repair (LPIHR) is one of the greatest concerns for surgeons. The present study was performed to evaluate the effects of iliopubic tract repair in LPIHR with respect to the recurrence rate, surgical outcomes, and complications.


LPIHR was performed in 3386 pediatric patients aged < 10 years from January 2016 to June 2018. The patients were categorized into two groups according to the operative techniques: high ligation alone (1736 patients) and additional iliopubic tract repair (1650 patients). In high ligation surgery, the hernia sac was removed and the peritoneum was closed. In iliopubic tract repair surgery, iliopubic tract and transversalis fascia arch sutures were added.


Recurrence only occurred in the high ligation group; no patients in the iliopubic tract repair group developed recurrence [0.35% (6/1736) vs. 0.00% (0/1650), respectively; p = 0.014]. Other surgical outcomes and complications did not differ between the two groups. Six patients in the high ligation group developed recurrence: four infants aged < 1 year and two children aged > 1 year. The mean duration from the first operation to reoperation in these six patients was 11.8 months; five patients developed recurrence within 1 year after the initial operation. All patients had a recurrent indirect hernia, and the location of the hernial defects was on the medial side of the previous stitch. The logistic regression indicated that the difference between the two groups affected the recurrence rate. This finding predicted that iliopubic tract repair is associated with a lower recurrence rate than high ligation (odds ratio  0.996, 95% confidence interval 0.994–0.999, p = 0.015).


This study of transabdominal LPIHR indicates that iliopubic tract repair results in a small but significant decrease in the risk of recurrence.

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We thank SR Kim, BS Oh, HY Lee, and JY Lee from the research center of Damsoyu Hospital for assisting with the statistical analysis and organizing the data in this manuscript. We also thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.


The authors have no financial ties to disclose.

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Correspondence to Sung Ryul Lee or Pyoung Jae Park.

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Sung Ryul Lee and Pyoung Jae Park have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the Institutional Review Board of Damsoyu Hospital (DSY-2019–003).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sung Ryul Lee and Pyoung Jae Park are co-first authors.

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Lee, S.R., Park, P.J. Adding iliopubic tract repair to high ligation reduces recurrence risk in pediatric laparoscopic transabdominal inguinal hernia repair. Surg Endosc 35, 216–222 (2021).

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  • Laparoscopic pediatric inguinal hernia repair
  • Iliopubic tract repair
  • Recurrence