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Laparoscopic Hernia Repair versus Open Herniotomy in Children: A Controlled Randomized Study
Rafik Shalaby1, Refaat Ibrahem, Mohamed Shahin
1Pediatric Surgery Unit, Al-Azhar University Hospitals, Cairo, Egypt.
Insights
Laparoscopic hernia repair in children offers reduced operative time and lower recurrence rates compared to open surgery. This minimally invasive approach also shows excellent cosmetic outcomes and avoids testicular complications.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
Background:
- Laparoscopic hernia repair in pediatric patients remains a subject of debate.
- Comparison between laparoscopic and open techniques is essential for optimal patient outcomes.
Purpose of the Study:
- To compare laparoscopic assisted hernia repair versus open herniotomy.
- Evaluate operative time, hospital stay, recurrence, and iatrogenic complications.
Main Methods:
- Randomized controlled trial with 250 pediatric patients.
- Two equal groups: laparoscopic repair (Group A) and open herniotomy (Group B).
- Preoperative and postoperative assessment of testicular volume and duplex studies.
Main Results:
- Laparoscopic repair demonstrated shorter operative times across unilateral, obese, and bilateral cases.
- Lower recurrence rate (0.8%) in the laparoscopic group compared to open herniotomy (2.4%).
- No instances of testicular atrophy or iatrogenic ascent of the testis reported with laparoscopic repair.
Conclusions:
- Laparoscopic hernia repair is an effective and safe procedure in pediatric patients.
- Offers significant advantages including reduced operative time, lower recurrence, and superior cosmetic results.
- Minimally invasive approach avoids specific testicular complications associated with open surgery.
Abstract:
Background. Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic assisted hernia repair versus open herniotomy as regards operative time, hospital stay, postoperative hydrocele formation, recurrence rate, iatrogenic ascent of the testis, testicular atrophy, and cosmetic results. Patients and Methods. Two hundred and fifty patients with inguinal hernia were randomized into two equal groups. Group A was subjected to laparoscopic inguinal hernia repair. Group B was subjected to open herniotomy. The demographic data were matched between both groups. Assessment of the testicular volume and duplex assessment in preoperative, early, and late postoperative periods were done. Results. All cases were completed successfully without conversion. The mean operative time for group A was 7.6 ± 3.5 minutes, 9.2 ± 4.6 minutes and 11.4 ± 2.7 minutes, for unilateral hernia, unilateral hernia in obese child, and bilateral hernia, respectively. The recurrence rate was 0.8% in group A, whereas in group B the recurrence rate was 2.4%. Conclusion. Laparoscopic hernia repair by RN is an effective line of hernia repair. It resulted in marked reduction of operative time, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of the testis, and excellent cosmetic results.
