Embryological Basis and Comparative Outcomes of Open versus Laparoscopic Repair in Pediatric Congenital Inguinal Hernia: A Narrative Review

Congenital inguinal hernias, arising from failed processus vaginalis and canal of Nuck involution, are among the most common pediatric conditions, with an incidence of 160 per 1,000 in very low birth weight infants. While open herniotomy has long been the gold standard, laparoscopic repair has gained popularity in recent decades. This review discusses the embryological basis of congenital inguinal hernias and compares two surgical techniques, open hernia repair and laparoscopic hernia repair, weighing the risks and benefits of each to help determine which approach should be the standard for pediatric patients. The literature presents conflicting findings and the preferred surgical method remains controversial as surgeons must weigh several clinical considerations. Open hernia repair offers the clear benefits of lower same-side recurrence, less pain, and the option of using caudal anesthesia. On the other hand, laparoscopic repair provides a decrease in some postoperative complications, shorter hospital stays, and the ability to detect contralateral defects. While laparoscopy offers some advantages in complication rates and contralateral assessment, this review concludes that open herniotomy remains a dependable and often preferable standard. Ultimately, the choice between techniques requires an individualized approach, balancing the superior same-side recurrence profile of open repair against the diagnostic and minimally invasive benefits of the laparoscopic method. This review further examines clinical diagnostic markers, the role of ultrasonography, and future innovations like robotics and percutaneous closures, weighing their clinical benefits against emerging economic consideration.