Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial
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Published on: December 23, 2022
Colin D Gause1, Maria G Sacco Casamassima1, Jingyan Yang2
1Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Laparoscopic inguinal hernia repair in children under 3 years showed similar pain and complication rates to open repair. Both methods offer high parent satisfaction, with laparoscopy potentially reducing operative time.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
Background:
- Laparoscopic inguinal hernia repair is gaining traction in pediatric surgery.
- Open repair is often preferred in younger children due to anesthesia and technical concerns.
Purpose of the Study:
- To compare outcomes of laparoscopic versus open inguinal hernia repair in children aged 3 years and younger.
- To assess pain, complications, and satisfaction in pediatric inguinal hernia repair.
Main Methods:
- A prospective, single-blind, randomized controlled trial involving children 3 years or younger with inguinal hernias.
- Patients were randomized to either laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH).
- Primary outcome was acetaminophen doses; secondary outcomes included operative time, complications, and parent satisfaction.
Main Results:
- No significant differences were observed in acetaminophen doses, length of stay, complications, or parent satisfaction between LH and OH groups.
- Laparoscopic repair demonstrated a significantly shorter operative time (p=0.003).
- No cases of testicular atrophy were reported at the 2-year follow-up.
Conclusions:
- Laparoscopic inguinal hernia repair is a safe and effective option for children 3 years and younger, yielding comparable results to open repair.
- Both laparoscopic and open techniques result in high parent/caregiver satisfaction.
- LH offers potential benefits in reduced operative time for pediatric inguinal hernia repair.
Purpose:
Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years.
Methods:
A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children ≤3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores.
Results:
Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5) and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent finding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years.
Conclusion:
Children ≤3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.
