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LAT-HSL and Standard Laparoscopic Ligation Show Comparable Safety but Differ in Operative Tradeoffs
In a randomized controlled trial of 104 boys aged 1–3 years, LAT-HSL and standard laparoscopic hernia sac ligation (LH) produced equivalent hernia recurrence and complication rates at six months, with no statistically significant difference in primary safety or efficacy outcomes. However, the two techniques diverged on secondary intraoperative measures: LAT-HSL reduced pneumoperitoneum exposure dramatically (median 1.5 vs. 24.0 minutes, P<0.001) while requiring modestly longer total operative time (30.0 vs. 24.0 minutes, P=0.001).
What Was Studied
The trial investigated whether LAT-HSL — a scrotal-approach technique performed under laparoscopic guidance — is equivalent to the established single-port laparoscopic hernia needle extraperitoneal high ligation (LH) in terms of postoperative hernia recurrence and overall complication rate within six months. Head-to-head prospective comparative data between these two approaches for pediatric indirect inguinal hernia had previously been limited, leaving surgical teams without direct randomized evidence to guide technique selection.
How It Was Studied
This multicenter, single-blind, prospective RCT was conducted across the pediatric surgery departments of two tertiary children’s medical centers in China, enrolling patients between April 2024 and June 2025. Eligible participants were male patients aged 1–3 years with primary unilateral indirect inguinal hernia confirmed by abdominal ultrasonography. A total of 104 patients were included in the final analysis, randomized to either the LH group (n=53) or the LAT-HSL group (n=51), and followed for six months postoperatively. Primary outcomes were hernia recurrence rate and overall complication rate; secondary outcomes captured intraoperative parameters including pneumoperitoneum duration, total operative time, end-tidal carbon dioxide levels, and medical consumable costs.
What Was Observed
- Primary outcomes were equivalent: Hernia recurrence rates and overall complication rates within six months did not differ significantly between the LAT-HSL and LH groups, indicating comparable short-term safety and efficacy for both procedures in this age group.
- Pneumoperitoneum duration was dramatically shorter with LAT-HSL: The LAT-HSL group experienced a median pneumoperitoneum time of just 1.5 minutes [IQR 1.0–2.5] compared to 24.0 minutes [IQR 18.0–30.0] in the LH group — a highly significant reduction (P<0.001). This translated into a lower proportion of patients in the LAT-HSL group showing normal-low end-tidal CO₂ values intraoperatively, suggesting reduced risk of hypocapnia.
- Total operative time was longer in the LAT-HSL group: Despite the abbreviated pneumoperitoneum phase, LAT-HSL required more total operating time overall (median 30.0 [24.0–42.0] minutes vs. 24.0 [18.0–30.0] minutes in the LH group; P=0.001), reflecting the additional steps involved in the scrotal approach.
- Hospital stay was marginally but significantly longer for LAT-HSL: Median hospital stay was 1.0 day in both groups, but the interquartile range was wider in the LAT-HSL group (1.0–2.0 days vs. 1.0–1.0 days; P=0.003), and LAT-HSL was associated with potentially lower medical consumable costs in centers relying on disposable laparoscopic hernia needles.
Why This Matters
Minimizing prolonged pneumoperitoneum in young children is a recognized surgical concern, as sustained CO₂ insufflation carries physiological implications including hypocapnia, which the abstract identifies as a measurable intraoperative risk with standard LH. LAT-HSL substantially reduces this exposure while maintaining equivalent clinical outcomes, offering a rationale for technique selection beyond simple operative efficiency. The cost consideration is also clinically relevant, as institutional reliance on disposable instruments directly affects the economic profile of each procedure.
How to Read This Result
These findings should be interpreted with caution: the trial is small (N=104), single-blind, restricted to two centers in a single country, and followed patients for only six months — a period that may be insufficient to detect late hernia recurrences that could shift the efficacy comparison.
Limitations
The study’s single-blind design introduces potential for performance and detection bias. Enrollment at only two tertiary centers in China limits the generalizability of findings to other healthcare settings and surgical practice environments. Six months of follow-up is short for a hernia repair outcome, and late recurrences may not have been captured. The trial enrolled only boys aged 1–3 years, meaning results cannot be extended to older children, girls, or bilateral hernia presentations. The overall sample size of 104 patients constrains statistical power for detecting smaller but clinically meaningful differences in complication rates.