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Published on: December 23, 2022
Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia
1Department of Peadiatric Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh.
Insights
Laparoscopic inguinal hernia repair in children shows comparable safety and effectiveness to open surgery. While operative time varies, laparoscopy significantly reduced contralateral metachronous inguinal hernia rates, suggesting potential long-term benefits.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Choosing between laparoscopic and open surgery involves considerations of operative time, hospital stay, and complications.
Purpose of the Study:
- To compare the outcomes of laparoscopic versus open inguinal hernia repair in children.
- To evaluate operative time, postoperative hospital stay, and complication rates between the two surgical approaches.
Main Methods:
- A prospective comparative study involving 62 children undergoing inguinal hernia repair.
- Patients were divided into two groups: laparoscopic (30 children) and open (32 children).
- Data collected included operative time, hospital stay duration, and postoperative complications.
Main Results:
- Laparoscopic repair identified and treated contralateral patent processus vaginalis in 66% of unilateral cases.
- Unilateral laparoscopic repair had a significantly longer operative time than open repair (p<0.001).
- Laparoscopic surgery showed a statistically significant reduction in contralateral metachronous inguinal hernia compared to open surgery (p<0.05).
- Postoperative hospital stay, scrotal hydrocele, and hernia recurrence rates were comparable between groups and not statistically significant.
- No cases of testicular atrophy or ascent were observed in either group.
Conclusions:
- Laparoscopic herniotomy is a safe and effective alternative to open repair in children.
- Laparoscopy may offer advantages in detecting and treating contralateral hernias.
- Further large-scale randomized trials are needed to definitively establish superiority.
Abstract:
Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ≥2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial.
