Efficacy of transumbilical single-port and two-port laparoscopy in the treatment of pediatric inguinal hernia: a systematic review and meta-analysis

Objective To systematically evaluate the perioperative efficacy and safety of transumbilical single-port laparoscopic surgery and two-port laparoscopic surgery in the treatment of pediatric inguinal hernia, and to provide high-quality evidence-based medical evidence for the selection of clinical surgical methods. Methods A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases to collect relevant controlled studies published from the establishment of the databases to December 31, 2025. After screening the literature and extracting data according to the pre-set inclusion and exclusion criteria, the ROB2 tool and ROBINS-I tool were used to evaluate the risk of bias in RCT and non-RCT studies, respectively. Meta-analysis was performed using RevMan 5.3 software and R software. Results A total of 13 studies were included, involving 22,846 children. Meta-analysis showed that the postoperative recurrence rate in the single-port laparoscopic group was significantly lower than that in the two-port laparoscopic group (RR = 0.60, 95% CI: 0.39–0.94, P = 0.02); there were no statistically significant differences between the two groups in terms of operation time (MD = −1.43, 95% CI: −3.42–0.57, P = 0.16), hospital stay (MD = −2.34, 95% CI: −7.73–3.06, P = 0.40), detection rate of contralateral occult hernia (RR = 1.03, 95% CI: 0.94–1.13, P = 0.55), conversion to open surgery rate (RR = 1.57, 95% CI: 0.14–17.93, P = 0.71), and the incidence of various postoperative complications (all P > 0.05). Subgroup analysis showed that in large sample size studies, the operation time in the single-port laparoscopic group was significantly shorter (MD = −4.27, 95% CI: −7.25–1.28, P < 0.001), and in small sample size studies, the recurrence rate advantage of the single-port laparoscopic group was more significant (RR = 0.43, 95% CI: 0.25–0.71, P = 0.001). Conclusion Transumbilical single-port laparoscopic surgery has a significant advantage in reducing postoperative recurrence rate in the treatment of pediatric inguinal hernia. In large sample size studies, its advantage in operation time is more evident, and its safety is comparable to that of two-port laparoscopic surgery. For medical centers with mature single-port operation techniques, single-port laparoscopy can be the preferred surgical method; for complex hernias or when technical conditions are limited, two-port laparoscopy remains a reliable choice.