Abstract
Background: This study aimed to evaluate the effectiveness of percutaneous internal ring suturing (PIRS) for pediatric inguinal hernia. While previous reviews have addressed pediatric laparoscopic hernia repair more broadly, the present review specifically focuses on PIRS, with particular emphasis on recurrence rates. Methods: We searched PubMed, Web of Science, and Scopus for studies evaluating PIRS in children. The database searches were conducted between May 2025 and July 2026. Studies were eligible if they included at least 50 pediatric patients with inguinal hernia, reported a minimum follow-up of 6 months, and provided recurrence rates. Of 206 articles screened, 10 studies met the inclusion criteria; study characteristics and outcomes were summarized descriptively. Risk of bias was assessed using JBI tools and RoB 2, as appropriate. Results: The included studies comprised 1934 patients undergoing 2405 PIRS procedures. Overall, 80 complications (3.33%) were reported, including 39 recurrences (1.62%). Other complications included hematomas, iliac vessel punctures, granulomas, and transient hydroceles. One patient developed adhesive ileus with bowel strangulation, which required resection of a part of the ileum. Intraoperative assessment identified 190 additional bilateral hernias, increasing the rate of bilateral cases from 11.92% to 18.88%. Among the 1061 patients with available contralateral patent processus vaginalis (CPPV) data, CPPV was identified in 194 (18.28%). One case of complete androgen insensitivity syndrome (CAIS) was identified during PIRS. The weighted mean age reported across eight studies was 3.05 years. Mean operative time ranged from 8.48 to 26.5 min for unilateral and 18.0 to 33.9 min for bilateral procedures. Conclusions: PIRS appears to be an effective minimally invasive technique for pediatric inguinal hernia repair, with a low reported recurrence and complication rate. The possibility of closing the inguinal canal on the opposite side and assessing the gonads in girls during the procedure seems to provide an advantage over open techniques.