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Mini-scar inguinal herniotomy in selected children: comparative analysis of safety, effectiveness, and parents'
Ayman Al-Jazaeri1, Noura Al-Hassan, Basmah Al-Hassan
1Department of Surgey, King Saud University, Riyadh, Saudi Arabia. aljazaeri@yahoo.com
Insights
Mini-scar inguinal herniotomy (MSIH) offers comparable safety and efficacy to conventional open inguinal herniotomy (COIH) in children. Parents reported higher satisfaction with MSIH due to smaller, less noticeable scars.
Area of Science:
- Pediatric surgery
- Minimally invasive surgical techniques
Background:
- Conventional open inguinal herniotomy (COIH) remains the standard for pediatric inguinal hernias.
- Laparoscopic techniques have not yet shown clear advantages over COIH.
- A modified, smaller incision COIH, termed mini-scar inguinal herniotomy (MSIH), presents a minimally invasive alternative.
Purpose of the Study:
- To compare the safety, efficacy, and parental attitudes between MSIH and COIH.
- To evaluate parental satisfaction with incision size and overall outcomes.
Main Methods:
- Retrospective review of pediatric inguinal herniotomy cases (January 2008 - April 2010).
- Exclusion criteria: infants <6 months, complicated hernias, or associated hydrocele.
- Prospective measurement of MSIH scar length, compared to matched COIH cases.
- Standardized parental questionnaires assessing operative outcomes, satisfaction, and scar perception.
Main Results:
- 145 patients identified; 113 interviewed. 40 underwent MSIH (mean scar 7.7mm), 73 underwent COIH.
- No significant differences in postoperative complications or recurrence rates between MSIH and COIH (2.5% vs 6.8%).
- Parents in the MSIH group were more likely to perceive the scar as smaller (OR 4.9) and report higher satisfaction (OR 10.8).
Conclusions:
- MSIH demonstrates comparable safety and efficacy to COIH in pediatric inguinal herniotomy.
- The smaller incision in MSIH significantly enhances parental perception and satisfaction.
- MSIH represents a viable minimally invasive option for selected pediatric patients.
Introduction:
Inguinal herniotomy in children is still dominated by conventional open inguinal herniotomy (COIH) as laparoscopic techniques have yet to demonstrate clear advantages. A technical modification that minimizes the incision of COIH in selected children can offer another minimally invasive alternative. A comparative analysis of safety, efficacy, and parental attitudes between mini-scar inguinal herniotomy (MSIH) and COIH was performed.
Materials And Methods:
All inguinal herniotomy cases performed between January 2008 and April 2010 were reviewed. Patients who were younger than 6 months, presented with complicated hernias, or had an associated hydrocele were excluded. In the MSIH group the final scar length was prospectively measured and then retrospectively compared with a matched group of COIH. Parents in both groups were then interviewed using a standardized questionnaire to inquire about operative outcomes, their satisfaction level, and perception of the incision size.
Results:
Of the 145 patients identified, 113 (79%) had completed the parental phone interview at a mean interval of 275±212 days. Forty (35%) underwent MSIH with a mean final incision length of 7.7±2 mm, and 73 (65%) underwent COIH. The two groups were similar in age, sex, and hernias' sides. Postoperative complication including recurrence rates did not differ between MSIH and COIH (2.5% versus 6.8%, P=.4). However, parents in the MSIH group were more likely to notice that the scar was smaller than what they have expected (odds ratio, 4.9; 95% confidence interval, 2.1-11.9) and were more likely to be very satisfied (odds ratio, 10.8; 95% confidence interval, 3.1-38).
Conclusion:
The safety and efficacy of MSIH are comparable to those of COIH. However, in the MSIH group, parents are more likely to notice the smaller scar, which might improve their satisfaction.