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Pediatric inguinal hernia: laparoscopic versus open surgery
Ramanathan Saranga Bharathi1, Manu Arora, Vasudevan Baskaran
1Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, India. sarangabharathi@rediffmail.com
Insights
Laparoscopic surgery (LS) for pediatric inguinal hernias (PIH) offers better cosmesis and detects more contralateral patencies than open surgery (OS). However, outcomes are similar, making OS a viable standard for unilateral cases, especially where resources are limited.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- General Surgery
Background:
- Open surgery (OS) is the traditional treatment for pediatric inguinal hernias (PIH).
- Laparoscopic surgery (LS) is an emerging alternative, but its adoption is debated.
- A comparison of surgical outcomes between LS and OS for PIH is needed.
Purpose of the Study:
- To compare the surgical outcomes of laparoscopic surgery (LS) versus open surgery (OS) for pediatric inguinal hernias (PIH).
- To evaluate differences in operation time, complications, pain, hospital stay, and cosmesis between the two surgical techniques.
Main Methods:
- A prospective study compared 85 children undergoing LS (51) or OS (34) for PIH.
- Data collected included operation time, intra/postoperative complications, pain, hospital stay, cosmesis, and testis size.
- Patients were followed up for an average of 3.5 months.
Main Results:
- LS was slightly faster than OS, but the difference was not statistically significant (P=0.06).
- Postoperative pain and complication rates were similar between LS and OS.
- LS demonstrated superior cosmesis and identified more contralateral patencies of the processus vaginalis (CPPV) for simultaneous repair.
Conclusions:
- Both LS and OS yield similar surgical outcomes for pediatric inguinal hernias.
- LS offers advantages in cosmesis and detecting/repairing CPPV.
- Open surgery remains a justifiable standard of care for unilateral inguinal hernias, particularly in resource-limited settings.
Background And Objectives:
Herniotomy/open surgery (OS) has been the time honored treatment for pediatric inguinal hernia (PIH). Laparoscopic surgery (LS) has recently emerged as an alternative in its management. However, controversy is rife on its feasibility and wider adoption. The present need is to know whether a significant difference exists in the surgical outcomes following either technique.
Methods:
In a prospective study between January and December 2006, 85 children underwent either LS (51) or OS (34) for PIH. Operation time, intra- and postoperative complications, postoperative pain, postoperative stay, cosmesis, and the size of testis were recorded and compared for differences in outcome. Patients were followed up for an average of 3.5 months.
Results:
All in the open group had unilateral (UL) hernias. The laparoscopy group had 6 (11.8%) bilateral (BL) hernias, and 10 (22.2%) contralateral patencies of processus vaginalis (CPPV) were detected intraoperatively and repaired simultaneously. Bilateral repairs were excluded from comparative analysis. LS was slightly quicker than OS to perform [25.31 min vs 30.65 min (P=0.06)]. The difference in pain perception, between LS and OS, was insignificant. Immediate postoperative recovery was delayed in more children undergoing LS (P=0.02), but the duration of hospital stay was similar (P=0.37). Complication rates were similar (P=0.96). Cosmesis in LS was superior to that in OS.
Conclusions:
Well-performed conventional herniotomy yields results similar to those of laparoscopic repair. Cosmesis and the ability to detect and simultaneously repair CPPV are the 2 main advantages of LS over OS. Keeping in mind the low incidence of meta-chronicity in UL hernias, insignificance of cosmesis over the groin, and the constraints of the developing world, conventional open herniotomy can justly be performed for UL hernias, as the standard of care, in centers lacking laparoscopy.
