**RESEARCH Open Access** ![](https://assets.reachrx.ai/images/10.1186%E2%98%8Ds12887-025-06362-5/_page_0_Picture_3.jpeg) # Evaluation of the feasibility and clinical benefits of day-case laparoscopic percutaneous internal ring suturing for pediatric inguinal hernia in a single institution Yiyao Bao1 , Duote Cai1 , Shoujiang Huang1 and Zhigang Gao1\* # **Abstract** **Background** Inguinal hernia is a common condition in children, and day-case surgery has been widely implemented in pediatric specialty hospitals, benefiting patients and their families. However, overnight hospital stays pose various inconveniences to children and parents. In this study, we aimed to optimize the day-case surgery model for inguinal hernia repair, evaluate the effectiveness and safety of day-case surgery in children with inguinal hernias, and compare the effects of different surgical methods on hospitalization duration and medical cost. **Methods** A retrospective cohort study was conducted to analyze surgical data from 14,197 children with inguinal hernias admitted from January 2019 to December 2023 using statistical methods, including independent sample *t*-tests, analysis of variance, and multiple linear regression analysis. **Results** The results showed that the day-case surgery model significantly shortened hospitalization duration and reduced medical cost. The hospitalization duration and medical cost in the laparoscopic percutaneous internal ring suturing group were significantly higher than those in the open traditional high ligation of the hernia sac group (*P*<0.05). However, the recurrence rate in the laparoscopic percutaneous internal ring suturing group was 0.035%, which was lower than that (0.107%) observed in the open traditional high ligation of the hernia sac group. Laparoscopic percutaneous internal ring suturing aided the detection of hidden hernia at a rate of 49.61%. **Conclusions** Day-case surgery offers significant benefits by reducing hospitalization duration and medical cost, whereas laparoscopic percutaneous internal ring suturing is better for detecting hidden hernias and shows excellent performance in reducing recurrence rates. Future research should focus on the promotion and optimization of day-case laparoscopic percutaneous internal ring suturing to enhance the treatment outcomes in pediatric inguinal hernias. **Keywords** Children, Day-case surgery, Inguinal hernia, Laparoscopy \*Correspondence: Zhigang Gao ebwk@zju.edu.cn Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang 310052, P.R. China ![](https://assets.reachrx.ai/images/10.1186%E2%98%8Ds12887-025-06362-5/_page_0_Picture_14.jpeg) Bao *et al. BMC Pediatrics* (2025) 25:992 Page 2 of 8 # **Background** Inguinal hernia is a medical condition that typically requires surgical intervention [\[1](#page-7-0)]. In operative procedures, the concept of ambulatory surgery was first proposed by British pediatric surgeon James Nicoll in 1909, defined as a surgical procedure or operation that is completed within 1 day (24 h; from admission to discharge) [[2\]](#page-7-1). Day-case surgery refers to a subset of ambulatory surgery that does not require overnight hospitalization. The day-case surgery model has been widely adopted in pediatric specialty hospitals, offering substantial benefits to patients and their families. Conversely, overnight hospitalization poses various challenges to children and their parents. In addition to affecting the growth and development of children, inguinal hernia imposes a burden on healthcare resources. Studies have suggested that several factors contribute to the occurrence of inguinal hernias, including genetics, environmental conditions, and physiological characteristics [\[3](#page-7-2)]. Currently, the primary treatment options include open and laparoscopic surgeries; however, these approaches have limitations, such as prolonged postoperative recovery periods and substantial medical costs [[4](#page-7-3)]. Therefore, developing more efficient treatment methods remains a challenge. In recent years, the day-case surgery model has garnered popularity in the medical field, with research suggesting that it effectively reduces hospitalization duration and medical cost [\[5](#page-7-4)]. However, systematic research on its specific application in pediatric inguinal hernia remains limited [\[6](#page-7-5)]. Day-case surgery offers multiple benefits, including reduced patient hospitalization risks, lower incidence of nosocomial infections, and improved patient satisfaction [\[7](#page-7-6)–[9\]](#page-7-7). Nonetheless, the efficacy and safety of this model for pediatric inguinal hernia have not been adequately validated, highlighting the need for further research. Therefore, in this study, we aimed to optimize the day-case surgery model for inguinal hernia repair, assess its efficacy and safety in children with inguinal hernia, and compare the effects of different surgical methods on hospitalization duration and medical cost. # **Methods** ## **Inclusion and exclusion criteria** The inclusion criteria for this study were as follows: (1) study period: January 1, 2019, to December 31, 2023; (2) age<18 years; and (3) patients with inguinal hernias undergoing high ligation of the hernia sac. The exclusion criteria were as follows: patients with (1) congenital metabolic diseases and (2) the following conditions: preoperative cardiac function index≥grade 2, Child–Pugh classification for liver function≥grade B, and glomerular filtration rate<90 mL/min. ## **Day-case surgery procedure** The day-case surgery procedures implemented are indicated a follows: *Initial consultation and preoperative:* Preparation The child undergoes the initial outpatient consultation. If the child meets the criteria for daycase surgery, the attending physician conducts a preoperative education and issues the examination instructions. Thereafter, the parents or guardians register at the admission preparation center, make an appointment, receive face-to-face education, and download the healthcare platform app to read the admission and disease education content at any time. The preparation center plans the preoperative examination route based on the corresponding instructions to minimize the child's hospital stay time. *Preoperative review:* Three days before the surgery, the surgeon reviews the child's preoperative examination results. If there are any abnormalities, telephone guidance for re-examination or timely intervention is provided. *Final confirmation:* One day before the surgery, the admission preparation center calls the parents to confirm the absence of surgical indications, such as fever and diarrhea, and conducts another admission education. If there are surgical contraindications, the surgery is rescheduled. *Admission and surgery day:* On the day of surgery, the child fasts according to the appointment sequence and arrives at the hospital to complete the admission procedures. The goal is to ensure that the interval between admission and surgery initiation is <3 h, thereby maximizing time for the surgery and postoperative observation. *Preoperative assessment and preparation:* Admission assessment and medical history collection are subsequently completed. At 2 h before the surgery, the child receives 5 mL/kg of sugar water orally. The surgeon and anesthesiologist jointly evaluate the child's condition and conduct preoperative discussions. *Sedation, anesthesia, and surgical technique:* At 30 min before the surgery, dexmedetomidine (2 µg/ kg) is administered via nasal drip for sedation, following a protocol implemented since October 2018. During the surgery, intraoperative temperature is maintained. Regional block anesthesia is preferably initiated; however, if general anesthesia with tracheal intubation is required, short-acting anesthetics are used with precisely calculated dosages. The surgical options include either an open technique with a small lower abdominal horizontal incision and Bao *et al. BMC Pediatrics* (2025) 25:992 Page 3 of 8 high ligation of the hernia sac, or a laparoscopic technique, with transperitoneal external internal ring ligation. Before the end of the surgery, ropivacaine is used for local infiltration at the incision site. *Postoperative feeding and discharge evaluation:* Following surgery, if the child shows signs of recovery, such as crying and feeding behavior, early sequential feeding of sugar water is started. If there is no obvious nausea or vomiting 1 h after the sugar water intake, milk is introduced (protocol since January 2018). The surgeon and anesthesiologist jointly reassess the child's condition. If the discharge criteria are met, the discharge procedures are processed. The discharge criteria include stable vital signs, no obvious nausea or vomiting 2 h after the first breastfeeding or 3 h after the first milk intake, no fever, no crying and restlessness, dry and clean incision dressing, and parents have mastered the precautions. If the discharge criteria are not met, the routine hospitalization process is initiated. *Post-discharge follow-up:* Within 24 h after discharge, follow-up is conducted through the healthcare platform app, with an outpatient review scheduled 1 week postoperatively. ## **Conventional hospitalization process** In the conventional hospitalization process, the child undergoes the initial outpatient consultation and is scheduled for hospitalization. Admission, preoperative education, and preoperative preparation are conducted 1 to 2 days before the surgery. On the surgery day, formula milk intake is withheld for at least 6 h and breast milk for at least 4 h. Sugar water (5 mL/kg) is administered orally 2 h before the surgery. Anesthesia options include: non-intubation general anesthesia+sacral canal anesthesia; or tracheal intubation general anesthesia, with anesthetic agents selected based on the anesthesiologist's clinical judgment. The surgical options include either an open technique with a small lower abdominal horizontal incision and high ligation of the hernia sac, or a laparoscopic technique, with transperitoneal external internal ring ligation. During the surgery, temperature management is maintained using room temperature control and warming blankets. After the surgery, no sedation or analgesia is administered. Water intake begins after 2 h, and milk is introduced after 6 h. Discharge typically occurs within 2–4 days, and follow-up is conducted via the healthcare platform app within 24 h after discharge, with an outpatient review scheduled 1 week postoperatively. #### **Surgical procedures** For inguinal indirect hernias, two primary surgical methods were used: high ligation of the hernia sac via a lower abdominal transverse incision, and laparoscopic external circumferential banding through the peritoneal cavity. Prior to the surgery, parents were informed about the surgical steps, expected duration, associated cost, and risks of postoperative complications. Based on this information, the parents were given the opportunity to choose the specific surgical method for their child. The surgical procedures implemented are as follows: *Open traditional high ligation of the hernia sac (high ligation of the hernia sac via a lower abdominal transverse incision):* The high ligation of the hernia sac is performed under combined spinal-epidural anesthesia. A 0.7 cm transverse skin incision is made on the lower abdomen, the spermatic cord is lifted, and the cremaster muscle is separated below the external ring. The hernia sac is identified and transected before releasing the proximal end to expose the peritoneal fat. *Laparoscopic external circumferential banding through the peritoneal cavity:* Under tracheal intubation anesthesia, the main endoscope is inserted through the umbilicus. A hernia hook needle is projected through the skin at the internal ring site on the affected side to perform external circumferential banding through the peritoneal cavity. In cases of bilateral hernias, both internal ring banding is performed. ## **Ethical considerations** This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and adhered to the principles of the Declaration of Helsinki (2024). Ethical approval was obtained from the Ethics Committee of the Children's Hospital affiliated with the Zhejiang University School of Medicine (approval number: 2024-IRB-0303-P-01). Given the retrospective nature of this study and its minimal risk, the need for patient consent was waived. #### **Patient grouping** Data were collected from 14,197 children with inguinal hernias who underwent high ligation of the hernial sac from January 2019 to December 2023. Patients were classified into the day-case surgery and control groups (undergoing conventional hospitalization) based on the day-case surgery status. Further categorization resulted in the following subgroups: laparoscopic day-case surgery (*n*=4,486), laparoscopic control (*n*=6,900), open daycase surgery (*n*=2,543), and open control (*n*=268). The hospitalization duration, medical cost, age, and delayed discharge rates were compared among these groups. Bao *et al. BMC Pediatrics* (2025) 25:992 Page 4 of 8 ## **Statistical analysis** Data were analyzed using independent-samples *t*-tests and multiple linear regression. ## **Results** #### **Basic patient characteristics** During the study period, a total of 14,197 children aged 0–18 years underwent high ligation of the hernial sac. The average age was 44.67±31.10 months, with an average hospitalization duration of 34.66±33.04 h and an average medical cost of 7,065.16±2,112.69 yuan. Based on the surgical method, 11,386 (80.2%) and 2,811 patients (19.8%) underwent laparoscopic percutaneous internal ring suturing and open traditional high ligation of the hernia sac, respectively. According to the hospitalization type, 7,029 patients (49.5%) underwent day-case surgeries and 7,168 patients (50.5%) were hospitalized. Among the children undergoing laparoscopic percutaneous internal ring suturing, 10,127 were preoperatively diagnosed with unilateral inguinal hernia. However, laparoscopic exploration revealed contralateral hidden hernias in 5,204 patients (49.61%). Postoperative recurrence was observed in four patients (0.035%) after laparoscopic percutaneous internal ring suturing and three patients (0.107%) after open traditional high ligation of the hernia sac. In the day-case surgery group, four patients were hospitalized: three patients underwent laparoscopic surgeries (due to allergic reactions in two patients and intraoperative bleeding in one patient), and one patient underwent open traditional high ligation of the hernia sac (due to intraoperative bleeding). All four patients were discharged without complications after 2 days of hospitalization. # **Univariate analysis** The independent-samples *t*-tests and chi-squared tests revealed that the laparoscopic percutaneous internal ring suturing group had significantly higher proportions of female patients, older-aged individuals, bilateral inguinal hernia cases, longer hospitalization durations, and higher medical costs than the open traditional high ligation of the hernia sac group (*P*<0.05). However, the proportion of day-case surgeries was significantly lower in the laparoscopic group than in the open traditional high ligation of the hernia sac group (39.40% vs. 86.59%, *P*<0.001), as shown in Table [1.](#page-3-0) ## **Group analysis** Patients were classified based on whether they underwent day-case surgery, and the univariate analysis was conducted (Table [2](#page-4-0)). Among the hospitalized patients, there was no significant difference in age between the laparoscopic and open traditional high ligation of the hernia sac groups (*P*=0.561). However, compared with the open traditional high ligation of the hernia sac group, the laparoscopic group had higher proportions of female patients and bilateral inguinal hernia cases, as well as longer hospital stays and higher medical costs (*P*<0.05). Similar trends were observed among patients who underwent day-case surgery (*P*<0.001). ## **Multivariate analysis** Using medical cost as the dependent variable, a multiple linear regression model was developed with sex, age, inguinal hernia type, hospitalization duration, day-case surgery status, and laparoscopic percutaneous internal ring suturing status as independent variables (Table [3](#page-5-0)). The model had an R2 value of 0.781, with a variance inflation factor (VIF) ranging from 1.0 to 3.4, indicating no multicollinearity among the variables. After adjusting for multiple factors, sex was not associated with medical cost (*P*=0.538). Age negatively correlated with medical cost, with older age linked to lower medical cost. Bilateral inguinal hernia and laparoscopic percutaneous internal ring suturing were associated with higher medical cost, but lower day-case surgery cost (*P*<0.001). Hospitalization duration was significantly associated with higher medical cost (*P*<0.001) and showed the strongest correlation among the statistically significant variables, with a standardized coefficient of 0.399. A second multiple linear regression model was constructed using hospitalization duration as the dependent variable (Table [4](#page-5-1)). The model had an R² value of **Table 1** Comparison of basic characteristics between the laparoscopic and conventional surgery groups | | Laparoscopic percutaneous
internal ring suturing group
(n=11,386) | Open traditional high liga
tion of the hernia sac group
(n=2,811) | t/χ2
value | P
value | |------------------------------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|---------------|------------| | Sex ratio (male/female) | 8,064/3,322 | 2,071/740 | 8.972a | 0.003 | | Age (months) | 46.37±32.12 | 37.82±25.43 | –15.087 | <0.001 | | Type of inguinal hernia (unilateral/bilateral) | 5,103/6283 | 2,434/377 | 1,579.389a | <0.001 | | Day-case surgery (yes/no) | 4,486/6,900 | 2,543/268 | 2,351.872a | <0.001 | | Hospitalization duration (h) | 40.65±33.48 | 10.40±15.61 | –70.320 | <0.001 | | Medical cost (yuan) | 7,850.97±1,492.05 | 3,882.25±944.97 | –175.190 | <0.001 | | Postoperative recurrence (yes/no) | 4/11,382 | 3/2808 | 1.117 a | 0.291 | a *χ2* value Bao *et al. BMC Pediatrics* (2025) 25:992 Page 5 of 8 **Table 2** Univariate analysis of the hospitalized and day-case surgery groups | surgery groups | | | | | |--------------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|---------------|------------| | | Laparoscopic
percutaneous
internal ring
suturing group | Open traditional
high ligation of
the hernia sac
group | t/χ2
value | P
value | | | Hospitalized surgery | | | | | Cohort | 6,900 | 268 | | | | size | | | | | | Sex | 4,941/1,959 | 208/60 | 4.595 | 0.032 | | ratio
(male/
female) | | | | | | Age | 43.81±32.54 | 45.24±39.60 | 0.582 | 0.561 | | (months) | | | | | | Type | 3,088/3,812 | 181/87 | 53.984 | <0.001 | | of
inguinal
hernia
(unilat
eral/bi
lateral) | | | | | | Hospi
talization
duration
(h) | 62.30±25.64 | 50.81±27.37 | –7.182 | <0.001 | | Medi
cal cost
(yuan)
Day
case
surgery | 8,495.39±1,522.87 | 5,454.78±1,847.62 | –26.593 | <0.001 | | Cohort
size | 4,486 | 2,543 | | | | Sex
ratio
(male/
female) | 3,123/1,363 | 1,863/680 | 10.449 | 0.001 | | Age
(months) | 50.30±31.04 | 37.04±23.32 | –20.249 | <0.001 | | Type
of
inguinal
hernia
(unilat
eral/bi
lateral) | 2,015/2,471 | 2,253/290 | 1,298.214 | <0.001 | | Hospi
talization
duration
(h) | 7.35±1.29 | 6.14±0.61 | –52.883 | <0.001 | | Medi
cal cost
(yuan) | 6,859.76±679.83 | 3,716.52±583.41 | –204.231 | <0.001 | 0.694, with a VIF ranging from 1.0 to 1.4, confirming no multicollinearity. After adjusting for multiple factors, sex and inguinal hernia type were not significantly associated with hospitalization duration (*P*=0.690 and 0.162, respectively). Age negatively correlated with hospitalization duration, and patients who underwent day-case surgery had shorter hospitalization durations (b = −0.016, *P*<0.05). Patients who underwent laparoscopic percutaneous internal ring suturing had slightly longer hospitalization duration than those who underwent open traditional high ligation of the hernia sac (b=2.993, *P*<0.001). ## **Discussion** This study highlights that day-case surgery shortens the hospitalization duration and ensures a high level of safety and efficacy, as evidenced by the lower incidence of postoperative complications than that associated with traditional methods [[10,](#page-7-8) [11](#page-7-9)]. By systematically comparing the clinical outcomes and economic burdens between daycase and traditional-hospitalization surgeries for pediatric inguinal hernias, our findings contribute valuable evidence to guide the broader application of day-case surgery. Notably, the incidence of complications, including reoperation and readmission, was extremely low, aligning with the findings of previous studies advocating outpatient surgery in similar contexts [[12,](#page-7-10) [13\]](#page-7-11). Overall, this study confirms the effectiveness of day-case surgery in pediatric patients and encourages a shift toward more efficient surgical practices in pediatric care [\[14](#page-7-12)]. Our research revealed that the proportion of female patients, older children, and bilateral inguinal hernia cases in the laparoscopic percutaneous internal ring suturing group were significantly higher than those in the open traditional high ligation of the hernia sac group. This group also experienced longer the hospital stays; and incurred higher medical costs (*P*<0.05). Notably, the proportion of day-case surgery in the laparoscopic percutaneous internal ring suturing group was significantly lower than that in the open traditional high ligation of the hernia sac group (39.40% vs. 86.59%, *P*<0.001). This trend may reflect aesthetic considerations, particularly among female patients, as laparoscopic percutaneous internal ring suturing typically results in minimal scaring and improved cosmetic outcomes. Additionally, institutional experience at our hospital has shown that patients undergoing open traditional high ligation of the hernia sac had faster postoperative recovery speed; accordingly, we attempted to transition open traditional high ligation of the hernia sac treatments from hospitalization procedures to day-case surgery. Gradually, we improved the process through multidisciplinary cooperation, further enabling the extension of day-case protocols to laparoscopic percutaneous internal ring suturing for patients who meet the day-case surgery conditions. This allowed for the discharge of patients within 24 h postoperatively. From a resource utilization perspective, laparoscopic percutaneous internal ring suturing naturally incurs higher costs than open traditional high ligation of the hernia sac due to specialized equipment and consumables. Bao *et al. BMC Pediatrics* (2025) 25:992 Page 6 of 8 **Table 3** Results of the multivariate analysis with medical cost as the dependent variable | Variable | Value | Coefficient | Standardized
coefficient | 95% CI | P-value | VIF | |---------------------------------------------------------|-----------------------------|-------------|-----------------------------|---------------------|---------|-------| | Sex | Male=1
Female=2 | 11.817 | 0.003 | –25.815–49.449 | 0.538 | 1.092 | | Age | Actual value | –8.812 | –0.130 | –9.363–−8.261 | <0.001 | 1.109 | | Type of inguinal hernia | Unilateral=1
Bilateral=2 | 747.891 | 0.177 | 713.235–782.548 | <0.001 | 1.129 | | Hospitalization duration | Actual value | 25.502 | 0.399 | 24.613–26.391 | <0.001 | 3.255 | | Day-case surgery status | Yes=1
No=0 | –203.710 | –0.048 | –263.583–−143.836 | <0.001 | 3.382 | | Laparoscopic percutaneous internal ring suturing status | Yes=1
No=0 | 2,855.768 | 0.539 | 2,808.398–2,903.138 | <0.001 | 1.345 | **Table 4** Results of the multivariate analysis with hospitalization duration as the dependent variable | Variable | Value | Coefficient | Standardized
coefficient | 95% CI | P-value | VIF | |---------------------------------------------------------|-----------------------------|-------------|-----------------------------|------------------|---------|-------| | Sex | Male=1
Female=2 | –0.142 | –0.002 | –0.838–0.555 | 0.690 | 1.092 | | Age | Actual value | –0.016 | –0.015 | –0.026– −0.006 | 0.002 | 1.108 | | Type of inguinal hernia | Unilateral=1
Bilateral=2 | –0.458 | –0.007 | –1.099–0.184 | 0.162 | 1.129 | | Day-case surgery status | Yes=1
No=0 | –54.031 | –0.818 | –54.693– −53.369 | <0.001 | 1.206 | | Laparoscopic percutaneous internal ring suturing status | Yes=1
No=0 | 2.993 | 0.036 | 2.118–3.869 | <0.001 | 1.340 | However, they offer distinct clinical advantages, including the ability to detect hidden hernia on the opposite side. This allows for complete simultaneous bilateral repair compared to performing two surgeries, thus alleviating the pain of multiple surgeries and also reducing surgical cost. The absolute value of recurrence rate in the laparoscopic percutaneous internal ring suturing group was lower than that in the open traditional high ligation of the hernia sac group. However, no statistically significant difference was observed between the two groups. This is partly due to the lower incidence rate, and it also reflects that our surgical quality control is relatively good and the recurrence rate is low in clinical practice. Furthermore, our results align with those of previous studies indicating that laparoscopic methods can effectively detect contralateral hidden hernias, thereby reducing reoperation risks in children. This finding suggests improved treatment efficiency and reduced medical cost [\[15](#page-7-13), [16\]](#page-7-14), supporting the notion that minimally invasive techniques may improve surgical outcomes [\[17](#page-7-15), [18\]](#page-7-16). These findings highlight the potential clinical and economic benefits of laparoscopic percutaneous internal ring suturing as a standard approach for pediatric inguinal hernia repair. This study reinforces the importance of exploring minimally invasive techniques in pediatric surgery to enhance patient outcomes and resource utilization [[19\]](#page-7-17). This study utilized a multiple linear regression model to systematically analyze the effects of factors such as gender and age on the medical expenses and hospitalization duration of children with inguinal hernia. The model had a good fit (medical expenses R² = 0.781, hospitalization duration R² = 0.694) and showed no evidence of multicollinearity interference, indicating that the results are reliable. Among the factors influencing medical expenses, the length of hospital stay emerged as the most crucial variable (standardized coefficient 0.399, *P*<0.05), consistent with clinical expectations. An extended hospital stay directly increases the cumulative costs of beds, nursing care, and medical consumables, thereby confirming the conclusion that "shortening the hospital stay is a key approach to controlling medical expenses." A negative correlation was observed between age in months and medical expenses (*P*<0.05). This finding may be attributable to the immature organ development, higher surgical risk, and need for meticulous perioperative monitoring in younger infants, which results in increased costs. Additionally, bilateral hernias are more complex than unilateral hernias, and the cost of laparoscopic percutaneous internal ring suturing equipment and consumables is higher, both leading to increased costs. Conversely, day-case surgery does not require overnight hospitalization, significantly reducing bed and nursing expenses, thus becoming an effective way to reduce costs (*P*<0.05). Importantly, gender did not have a significant effect on medical expenses (*P*>0.05), suggesting that clinical costcontrol need not be differentiated based on gender. Bao *et al. BMC Pediatrics* (2025) 25:992 Page 7 of 8 Analysis of factors influencing hospitalization duration revealed a negative correlation with age (*P*<0.05), indicating that younger children have a slower postoperative recovery and require longer observation periods. Day-case surgery, as a typical model of the rapid rehabilitation concept, significantly shortens the hospitalization time (b = −0.016, *P*<0.05), while laparoscopic percutaneous internal ring suturing, although more expensive than open traditional high ligation of the hernia sac, has a slightly longer hospitalization time (b=2.993, *P*<0.001). This may be attributed to the minimally invasive nature and reduced postoperative pain of laparoscopic percutaneous internal ring suturing, which helps to mitigate the effect of hospitalization delay caused by the operation time. It also provides data support for "the application value of laparoscopic percutaneous internal ring suturing in efficient diagnosis and treatment". Furthermore, gender and hernia type had no significant impact on hospitalization time (*P*>0.05), indicating that these two factors are not the key focus of hospitalization cycle management. The clinical significance of this study lies in its contribution to implementing day-case surgery and laparoscopic techniques in pediatric care. Our findings demonstrate that these methods significantly reduce hospitalization duration and medical cost, thereby improving the overall patient experience and healthcare resource efficiency [[20,](#page-7-18) [21\]](#page-7-19). Notably, the day-case surgery model enhances patient satisfaction while alleviating financial burdens on families and healthcare systems [\[14](#page-7-12), [22\]](#page-7-20). However, variability in surgical outcomes and patient selection criteria may affect the applicability of these results to broader populations, necessitating further research to standardize protocols and assess long-term outcomes [[23\]](#page-7-21). Future studies should refine the patient selection criteria and explore the broader effect of these surgical models on healthcare policies to optimize pediatric surgical care [[24\]](#page-7-22). The strengths of this study include the analysis of data from over 14,000 pediatric patients, which ensures robust statistical power, broad applicability of the findings, and enhanced reliability and external validity of the conclusions. Additionally, multiple statistical methods, including independent-samples *t*-tests, analysis of variance, and multiple linear regression analysis, were used to ensure comprehensive and accurate data analysis. These methods allow for a more precise evaluation of the effects of different surgical techniques. Furthermore, data collection spanned 5 years, providing reliable information on the long-term outcomes of surgeries. This helps in understanding the performance of various surgical methods in real-world clinical settings. However, the study has some limitations. First, owing to the retrospective nature, this study is subject to potential selection bias and uncontrolled confounding factors, which may affect the validity and generalizability of the findings. Additionally, the data were sourced from a single medical institution, which may limit the universal applicability of the results. Differences in medical practices and patient demographics across different regions necessitate further validation to confirm the broad applicability of the findings. ## **Conclusions** In conclusion, this study demonstrates that day-case surgery is a safe and reliable option for treating pediatric inguinal hernias, effectively reducing hospitalization duration and medical cost. Additionally, laparoscopic percutaneous internal ring suturing offers potential advantages in detecting contralateral hidden hernias, thereby reducing the need for subsequent surgeries, despite its slightly higher medical cost. Our findings support the adoption of day-case laparoscopic percutaneous internal ring suturing in clinical practice to improve patient treatment experience and optimize resource utilization efficiency. #### **Abbreviations** STROBE Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) VIF Vvariance inflation factor ## **Supplementary Information** The online version contains supplementary material available at [https://doi.or](https://doi.org/10.1186/s12887-025-06362-5) [g/10.1186/s12887-025-06362-5](https://doi.org/10.1186/s12887-025-06362-5). Supplementary Material 1. #### **Acknowledgements** Not applicable. #### **Authors' contributions** YB: Conceptualization, investigation, writing—original draft, methodology, writing—review and editing, formal analysis, project administration, and data curation. DC: Data curation, supervision, methodology, writing—review and editing, and conceptualization. SH: Data curation, supervision, methodology, writing—review and editing, conceptualization. ZG: Conceptualization, investigation, writing—review and editing, project administration, methodology, validation, funding acquisition. #### **Funding** This research was supported by the Zhejiang Provincial Medical and Health Science and Technology Program (Grant No. 2023KY828). #### **Data availability** The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request. All the datasets have been presented in the article. ## **Declarations** #### **Ethics approval and consent to participate** This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and adheres to the principles of the Declaration of Helsinki. Ethical approval was Bao *et al. BMC Pediatrics* (2025) 25:992 Page 8 of 8 obtained from the Ethics Committee of the Children's Hospital affiliated with the Zhejiang University School of Medicine (Hangzhou, China; approval number: 2024-IRB-0303-P-01). Owing to the retrospective nature of this study and its minimal risk, the need for patient consent was waived. #### **Consent for publication** Not applicable. #### **Competing interests** The authors declare no competing interests. Received: 22 September 2025 / Accepted: 3 November 2025 #### **References** - 1. Kılıç S. Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children. Ann R Coll Surg Engl. 2024;106:718–23. - 2. Nicoll JH. The surgery of infancy. Br Med J. 1909;2:753–6. - 3. Besch BM, Curtin K, Ritch R, Allingham RR, Wirostko BM. Association of exfoliation syndrome with risk of indirect inguinal hernia: the Utah project on exfoliation syndrome. 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