To investigate the diagnostic features of pediatric pantaloon hernia and to evaluate the outcomes of laparoscopic surgical treatment.

The clinical data of four children diagnosed with pantaloon hernia and treated at Xiamen Children's Hospital (Xiamen Hospital of the Pediatric Hospital Affiliated to Fudan University) between March 2019 and April 2024 were retrospectively reviewed, and the relevant literature was analyzed.

All four patients were male, aged from 2 years and 1 month to 4 years and 5 months, with a mean age of 3 years and 3 months. Patient 1, aged 2 years and 1 month, experienced recurrence on the day of the initial operation for indirect inguinal hernia. During the second operation, the original indirect hernia sac was found to be completely ligated, and a direct hernia sac was identified on the same side after traction of the inguinal skin, leading to the diagnosis of pantaloon hernia. Laparoscopic high ligation of the direct hernia sac was performed, followed by coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 4 years of follow-up. Patient 2, aged 2 years and 3 months, developed recurrence 1 month after the initial operation performed at another hospital. At reoperation, the original indirect hernia sac was completely ligated, and a direct hernia sac was detected on the same side after traction of the inguinal skin. Pantaloon hernia was diagnosed intraoperatively. Laparoscopic high ligation of the direct hernia sac with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament was performed. No recurrence was observed during 3 years of follow-up. Patient 3, aged 4 years and 5 months, was diagnosed with pantaloon hernia during the initial operation. Laparoscopic high ligation of both the indirect and direct hernia sacs was performed, followed by coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 18 months of follow-up. Patient 4, aged 3 years and 1 month, was diagnosed with pantaloon hernia during the initial operation. Laparoscopic high ligation of both the indirect and direct hernia sacs was performed, with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament. No recurrence was observed during 6 months of follow-up.

Preoperative diagnosis of pantaloon hernia in children is challenging and the condition is prone to missed diagnosis. Laparoscopic high ligation of both indirect and direct hernia sacs combined with coverage of the direct hernia triangle using the ipsilateral medial umbilical ligament is a feasible and effective treatment for pediatric pantaloon hernia.