Simple Purse String Laparoscopic Versus Open Hernia Repair

To compare surgical outcomes for a simple purse string method of laparoscopic hernia (LH) repair with a traditional open inguinal hernia (OH) repair in children in a single center.

Following ethical approval, a retrospective review of all children undergoing LH repair from January 2010 to December 2013 versus a historic cohort of all OH repairs between January 2010 and December 2011 was conducted. LH repair was performed by a simple purse string technique using nonabsorbable braided suture. Groups were compared using the independent t test or the Mann-Whitney test as appropriate.

One hundred three patients (23 females, 80 males) underwent LH repair over the 4-year period compared with 151 (25 females, 126 males) OH procedures in the first 2 years. Median age in the LH group was 0.56 years (range, 0.04-14.7 years) compared with 0.52 years (range, 0.04-13.47 years) in the OH group (P = .81). In the LH group the intended operation was bilateral in 18 (17.4%); 85 were clinically unilateral, but at operation a contralateral patent processus vaginalis was repaired in 26 (30.5%). Median operative time was 50.5 minutes (range, 20-95 minutes) in the LH group and 20 minutes (range, 10-90 minutes) in the OH cohort (P < .0001). Recurrence rate was 2.9% in the LH group and 3.9% in the OH group, and overall complication rates were 7.8% and 9.9%, respectively.

LH repair yields similar results to OH repair; however, the operation time is significantly longer. All complication rates were statistically similar on balance. Almost one-third of LH procedures resulted in concurrent detection and repair of a contralateral patent processus vaginalis at laparoscopy.