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A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children
Antti I Koivusalo1, Reijo Korpela, Kari Wirtavuori
1Section of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. antti.koivusalo@hus.fi
Insights
Pediatric inguinal hernia repair outcomes are similar for laparoscopic surgery and open repair. However, laparoscopic repair involves longer operating times and increased postoperative pain in children.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- The efficacy of laparoscopic surgery for pediatric inguinal hernia repair remains debated.
- Open repair is the traditional method, but minimally invasive techniques are increasingly explored.
Purpose of the Study:
- To compare day-case laparoscopic hernia repair with open repair in children.
- To evaluate recovery time, postoperative pain, operative time, and complications.
Main Methods:
- A prospective, single-blinded randomized study included 89 children (4 months to 16 years) with unilateral inguinal hernia.
- Primary outcome: time to normal daily activities. Secondary outcomes: pain, operative time, results, complications.
Main Results:
- Mean time to normal activity was similar (2.4 days laparoscopic vs. 2.5 days open).
- Laparoscopic repair had significantly higher rates of rescue analgesia (79% vs. 42%) and higher pain scores.
- Operative time was longer for laparoscopic repair (63 min vs. 38 min).
Conclusions:
- Open and laparoscopic hernia repair yield similar recovery and outcomes in children.
- Laparoscopic repair in children is associated with increased operative time and postoperative pain.
Objective:
The role of laparoscopic surgery in pediatric inguinal hernia repair is unclear. We aimed to compare day-case laparoscopic hernia repair with open repair.
Methods:
A prospective, single-blinded randomized study in children aged 4 months to 16 years with unilateral inguinal hernia was performed. The primary outcome measure was the time to normal daily activities after surgery. Secondary outcome measures included postoperative pain, time in the operation room, results, and complications.
Results:
Eighty-nine patients were enrolled (laparoscopic hernia repair: 47, open repair: 42). The mean number of days to normal activity after laparoscopic hernia repair and open repair was 2.4 and 2.5, respectively. Thirty-seven (79%) patients with laparoscopic hernia repair and 20 (42%) with open repair required rescue analgesia postoperatively. The median pain score in the second postoperative morning was significantly higher after laparoscopic hernia repair. The median times in the operation room for laparoscopic hernia repair and open repair were 63 and 38 minutes, respectively. Surgical and cosmetic results were similar at up to 2 years' follow-up.
Conclusions:
Recovery and outcome were similar after open repair and laparoscopic hernia repair in children. Laparoscopic hernia repair was associated with increased theater time and postoperative pain.
