Single-incision laparoscope-assisted trans-scrotal hernia sac ligation (LAT-HSL): Technique description and feasibility study in pediatric inguinal hernia

Introduction: Laparoscopic repair has become the mainstream for paediatric inguinal hernia. However, mainstream techniques such as laparoscopic percutaneous extraperitoneal closure rely on a ‘blind’ extraperitoneal needle circumnavigation, carrying potential risks of cord structure injury and a notable learning curve. A more visualised and simplified approach is desirable. Patients and Methods: This prospective observational study enrolled 36 male children (median age: 14.5 months) with unilateral indirect inguinal hernia between April 2024 and April 2025. The core innovation of laparoscope-assisted transscrotal hernia sac ligation (LAT-HSL) is the ‘cannulation of the hernia sac’ method: under laparoscopic vision, the scope is advanced through the internal ring into the hernia sac, creating a lighted tract to guide a minimal scrotal incision for direct sac dissection and high ligation. Primary outcomes were technical success rate and operative times. Secondary outcomes included complications, hospital stay, costs and recurrence. Results: LAT-HSL was successful in 34/36 cases (94.4%), with two conversions due to adhesions. Median operative time was 21 min (interquartile range [IQR] 16–27), and pneumoperitoneum time was 2.0 min (IQR 1.1–3.6). Complication rate was 5.8% (minor Clavien–Dindo I/II), with no cord injuries or recurrence at 6-month follow-up. Median cost was $875, with disposable instruments at 7.9%. Conclusion: The LAT-HSL technique is a feasible and safe minimally invasive alternative for paediatric inguinal hernia repair. It offers a fully visualised dissection path, drastically reduces pneumoperitoneum time and potentially simplifies learning by utilising familiar open surgical skills under laparoscopic guidance, while also demonstrating a favourable cost structure. These preliminary findings warrant further comparative studies.