To compare the clinical efficacy of totally transumbilical single-port laparoscopic surgery and surgery through a small transverse abdominal skin-crease incision in children with inguinal hernia, and to evaluate differences in treatment outcomes between the two surgical approaches across different age groups.

This prospective randomized controlled trial included 120 children with inguinal hernia who underwent surgical treatment at the First Affiliated Hospital of Xinjiang Medical University between January 2023 and January 2025. The children were randomly assigned, using a simple random number method, to either the control group (surgery through a small transverse abdominal skin-crease incision) or the study group (totally transumbilical single-port laparoscopic surgery), with 60 children in each group. Perioperative outcomes, including incision length, operative time, intraoperative blood loss, time to first postoperative flatus, and length of hospital stay, were compared between the two groups. Pain intensity was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Pediatric quality-of-life scores and postoperative complications were also evaluated. In addition, the children were stratified into two age groups (3–6 years and 7–12 years), and treatment outcomes were compared between the two surgical approaches within each age stratum.

All perioperative outcomes were significantly more favorable in the study group than in the control group (all P<0.05). The pooled effect size for the perioperative outcomes indicated a large between-group difference (Hedges' g=2.44). Compared with preoperative values, postoperative pain scores decreased, while physical and emotional functioning scores increased in both groups. These improvements were significantly greater in the study group than in the control group (all P<0.05). All postoperative between-group effect sizes were large (Hedges' g>0.8). The overall incidence of postoperative complications was significantly lower in the study group than in the control group [odds ratio (OR)=0.183, P=0.004]. Intraoperative exploration identified occult contralateral inguinal hernias in eight children in the study group. In both age strata, the study group demonstrated significantly more favorable perioperative outcomes, lower pain scores, and higher pediatric quality-of-life scores than the control group (all P<0.05). Among children aged 7–12 years, the difference in complication rates between the two groups was not statistically significant. However, among children aged 3–6 years, the complication rate remained significantly lower in the study group than in the control group (P<0.05).

Both totally transumbilical single-port laparoscopic surgery and surgery through a small transverse abdominal skin-crease incision achieve reliable efficacy for pediatric inguinal hernia. The laparoscopic approach allows intraoperative detection of occult contralateral inguinal hernias, causes less surgical trauma, and facilitates faster postoperative recovery. Younger children may derive greater benefits from this approach in terms of reducing postoperative complications.