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Unilateral inguinal hernia: laparoscopic or inguinal approach. Decision making strategy: a prospective study
C Esposito1, I Giurin, F Alicchio
1Department of Pediatrics, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it
Insights
Parents overwhelmingly prefer laparoscopic repair for unilateral inguinal hernias in children, citing convenience and avoiding repeat anesthesia. This approach is favored over traditional inguinal exploration due to these parental concerns.
Area of Science:
- Pediatric Surgery
- Surgical Decision-Making
- Parental Preferences
Background:
- Management of contralateral inguinal region in children with unilateral inguinal hernia lacks consensus.
- Parental perspectives are rarely considered in surgical management decisions.
- Unilateral inguinal hernias require careful consideration of potential contralateral patency.
Purpose of the Study:
- To evaluate parental views on managing the contralateral region in pediatric unilateral inguinal hernia.
- To understand parental decision-making factors regarding surgical options.
- To compare parental preferences for laparoscopic versus inguinal repair.
Main Methods:
- Prospective study of 100 children under 12 with unilateral inguinal hernia.
- Oral interviews and study forms to gather parental opinions on hernia nature and surgical options.
- Analysis of parental decisions and surgical outcomes.
Main Results:
- 89 parents opted for laparoscopic repair, citing convenience and avoidance of a second anesthesia.
- 11 parents preferred inguinal exploration due to fear of new surgical technology.
- Parents predominantly favored the laparoscopic approach for unilateral inguinal hernias.
Conclusions:
- No consensus exists among surgeons regarding contralateral region management in pediatric unilateral inguinal hernia.
- Involving parents in decision-making by presenting both surgical options is crucial.
- Parental preference strongly leans towards laparoscopic inspection and repair for unilateral inguinal hernias.
Abstract:
The management of the contralateral region in a child with a known unilateral inguinal hernia is a debated issue among paediatric surgeons. The available literature indicates that the perspective of the child's parents is seldom. This study was performed to evaluate parents' views on this topic. After the Ethical Committee's approval, 100 consecutive patients under 12 years of age with a unilateral inguinal hernia were studied prospectively from March 2010 to September 2010. After an oral interview, a study form was given to the parents about the nature of an inguinal hernia, the incidence of 20 to 90% of a contralateral patency of the peritoneal-vaginal duct and the possible surgical options (inguinal repair or laparoscopic repair). The parents' decision and surgical results were analyzed. Eighty-nine parents chose laparoscopic approach, and 11 parents preferred inguinal exploration. Regarding their motives, all 89 parents requesting laparoscopic approach indicated that the convenience and risk to have a second anaesthesia was the primary reason of their decision. The 11 parents who preferred inguinal approach indicated that the fear of a new surgical technology was their primary reason. Conclusion There is no consensus about the management of paediatric patients with a unilateral inguinal hernia. We believe that a correct decision-making strategy for parents' choice is to propose them the both procedures. Our study shows that parents prefer laparoscopic inspection and repair in the vast majority of cases.