Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes

•Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy.•Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors.•Our data supports growing favourable evidence on laparoscopic sac division techniques. Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and ‘purse-string’ closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort. LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (