Pediatric inguinal hernia is one of the most common conditions in pediatric surgery, primarily associated with the incomplete or partial closure of the processus vaginalis. Its incidence ranges from 1% to 4%, with a notably higher prevalence in boys under 1 year of age.1 Traditional open hernia repair, while simple and effective, has gradually been superseded by laparoscopic techniques due to the rapid advancement of minimally invasive surgery and laparoscopy. As a result, high ligation of the internal ring via laparoscopy has become a routine procedure in many medical centers.1,2 Compared to open surgery, laparoscopy allows direct visualization of both internal inguinal rings, reducing disturbance to the spermatic cord and vas deferens. It also offers advantages such as smaller incisions, quicker recovery, and improved cosmetic outcomes.1, 2, 3

Currently, laparoscopic techniques for pediatric inguinal hernia repair include both intraperitoneal and extraperitoneal suture ligation methods. The extraperitoneal suture ligation, commonly known as laparoscopic percutaneous extraperitoneal closure of the internal ring, involves performing an extraperitoneal purse-string suture around the internal ring under laparoscopic guidance.4 Building upon this, the ‘single-port laparoscopy’ technique was developed to further reduce trauma and enhance aesthetic outcomes, and is gradually being adopted in various centers. Single-port laparoscopy typically involves inserting the laparoscope and instruments through a single incision at the umbilicus, resulting in nearly invisible scars and reducing the risk of damage and postoperative pain associated with multiple punctures.4,5 However, single-port surgery has greater limitations in terms of suture angles and working space, leading to issues such as instrument interference and increased operational difficulty. This requires the operator to possess advanced laparoscopic skills.5 Furthermore, some studies have raised concerns regarding the recurrence rate and surgical safety of single-port laparoscopy when the internal ring is large or multiple peritoneal folds are present.6 In contrast, multi-port laparoscopy provides more room for operation and allows for more straightforward suturing. However, it increases the number of incisions in the abdominal wall, which may compromise the cosmetic outcome and increase the risk of complications.4

In summary, both single-port and multi-port laparoscopic methods have distinct characteristics in the treatment of pediatric inguinal hernia. The single-port technique minimizes visible scarring and highlights the advantages of minimally invasive surgery, but operational limitations and instrument interference may increase risk.7 On the other hand, the multi-port method is easier to perform, with a shorter learning curve, but results in more incisions, which raises concerns about the cosmetic outcome.7 While some retrospective and single-center studies have compared the advantages and disadvantages of single-port and multi-port approaches in pediatric inguinal hernia repair, these studies often suffer from small sample sizes and inconsistent designs, leading to a lack of systematic and objective evidence to help clinicians evaluate and select the optimal approach.

Based on the above background, this study aims to conduct a systematic review and meta-analysis to synthesize previously published research, exploring the differences in safety and efficacy between single-port and multi-port laparoscopy for pediatric inguinal hernia repair. The analysis will focus on intraoperative technical difficulties, perioperative complications, postoperative recurrence rates, and cosmetic outcomes, providing evidence-based guidance to inform clinical decision-making and personalized treatment strategies for patients.