The anatomy and variations of the inguinal canal significantly influence outcomes of laparoscopic inguinal hernia (IH) repair in pediatric patients. Male anatomy, with the spermatic cord and vascular structures, presents greater surgical complexity and risk. Although laparoscopy improves anatomical visualization, few studies have explored its impact on pediatric outcomes.

This retrospective study analyzed 158 male children who underwent laparoscopic IH repair between November 2019 and December 2023. Data included age, hernia side, internal ring shape, inferior epigastric artery (IEA) configuration, lipoma, and peritoneal band presence.

Of 207 hernias, 59.5% were right-sided and 40.5% left-sided. Age significantly correlated with IEA prominence (χ2 = 13.367, p = 0.0096) and lipoma presence (χ2 = 21.330, p = 0.0063). The most common IEA configuration was "Common Wall"; the "Distant" type increased with age. Hematomas were the most frequent complication (13.53%), especially in infants (1–12 months). The "Intersection" IEA configuration was associated with higher complication rates.

IEA and inguinal canal variations are key determinants in pediatric laparoscopic IH repair outcomes. Awareness of these anatomical features, especially in infants, can help reduce complications. Further research may aid in refining surgical approaches and enhancing safety.