WOFAPS 2025 8th World Congress of Pediatric Surgery

Pablo María Ruiz Hernandez, María Rosa Ibarra Rodriguez, Francisco Javier Murcia Pascual, Fernando Vazquez Rueda, Alvaro Naranjo Torres, Rosa María Paredes Esteban

Hospital Universitario Reina Sofía- Córdoba- Spain

INTRODUCTION
Direct inguinal hernia is a relatively rare condition in the pediatric population, with an incidence of up to 1.5%, showing higher prevalence among premature infants. Its origin may be congenital or acquired. Open surgical repair remains the treatment of choice; however, in cases of recurrence or diagnostic uncertainty, alternative techniques may prove beneficial.

CASE PRESENTATION
A 6-year-old male patient, previously operated on for an indirect inguinal hernia, was referred to our hospital due to a recurrence of hernia. Physical examination revealed findings consistent with a direct inguinal hernia, prompting video-assisted laparoscopic surgery with plug placement. During follow-up, the patient presented with the same clinical symptoms, and a reoperation was performed using the Transabdominal Preperitoneal (TAPP) approach. This technique involves creating a peritoneal flap and placing a mesh to reinforce the defect.

Using three 5 mm trocars and performing dissection of the inguinal rings, herniated preperitoneal fatty tissue was identified medial to the epigastric vessels. The contents were reduced via countertraction maneuvers. A prosthetic mesh was subsequently placed in the dissected preperitoneal space without the need for fixation, and the peritoneal flap was closed using barbed suture. One year postoperatively, the patient remains asymptomatic.

CONCLUSION
Open surgery continues to be the gold standard for the treatment of direct inguinal hernias in children. However, the TAPP technique, widely adopted in adult surgical practice, may represent a valuable option in managing recurrent hernias in the pediatric population.