Laparoscopic identification and management of a pediatric direct inguinal hernia in a high-risk infant: A case report

Direct inguinal hernia is rare in children and may be underrecognized. We report a high-risk infant with extreme prematurity and prolonged positive-pressure ventilation who developed recurrent inguinal hernias despite anatomically appropriate laparoscopic repairs. Serial laparoscopic reassessments revealed dynamic progression from bilateral indirect hernias to pantaloon hernias and ultimately a persistent direct defect. Definitive repair was deferred until three years of age when incarceration occurred. Laparoscopic reassessment confirmed a right indirect and left direct hernia. Percutaneous internal ring closure and open Lichtenstein tension-free mesh repair achieved durable repair without recurrence at 12-month follow-up. • Direct inguinal hernia is exceedingly rare and underrecognized in children • Sustained positive-pressure ventilation may be a major contributor to hernia recurrence in high-risk infants • Pediatric inguinal hernia anatomy may evolve over time, and laparoscopic reassessment is essential for appropriate surgical decision-making