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Published on: November 12, 2021
Choice of Repairing Inguinal Hernia in Children: Open Versus Laparoscopy
Venkatachalam Raveenthiran1, Prakash Agarwal2
1Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, Tamil Nadu, India. vrthiran@yahoo.co.in.
Insights
Pediatric inguinal hernia repair involves open or laparoscopic surgery. This review helps pediatricians guide parents on the best surgical approach based on the child's specific condition and hernia type.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Evidence-Based Medicine
Background:
- Inguinal hernia is a common childhood condition requiring surgical intervention.
- Traditional open inguinal incision is being compared with newer laparoscopic repair techniques introduced in 1990.
- Parental information seeking necessitates evidence-based guidance for pediatricians.
Purpose of the Study:
- To provide pediatricians with updated evidence on pediatric inguinal hernia repair methods.
- To enable informed counseling of parents regarding surgical choices.
- To define unacceptable standards and propose rationalized recommendations for herniotomy.
Main Methods:
- Descriptive review of current literature on pediatric inguinal hernia repair.
- Analysis of evidence comparing open herniotomy and laparoscopic repair.
- Identification of specific clinical scenarios favoring each surgical approach.
Main Results:
- Laparoscopic repair shows benefits in bilateral hernias in girls, giant hernias, recurrent cases, and hernias with undescended testes or ambiguous genitalia.
- Open herniotomy is advantageous for male unilateral hernias, premature newborns, failed laparoscopic repairs, and cases with significant comorbidities.
- The choice of surgical method depends on patient demographics, hernia characteristics, and associated conditions.
Conclusions:
- The optimal surgical approach for pediatric inguinal hernia is condition-dependent.
- Pediatricians require up-to-date evidence to guide parents in selecting the most appropriate herniotomy technique.
- A balanced consideration of laparoscopic and open methods is crucial for successful pediatric hernia management.
Abstract:
Inguinal hernia is a common disorder of childhood that requires surgical repair at diagnosis. Traditionally, it is operated upon by open inguinal incision. However, with the introduction of laparoscopic repair in 1990, opinion of scientific community is divided concerning the best method of pediatric herniotomy. Educated parents, who long to have the choicest of the best, often gather information from internet and prefer to discuss their concerns with primary care physicians. This descriptive review is intended to provide practicing pediatricians with updated evidence-based information which will enable them to counsel parents regarding the choice of hernia repair. Based on careful analysis of current literature, unacceptable standards are defined in this paper and rationalized recommendations are proposed. Laparoscopy appears to be beneficial in bilateral hernia of girls, giant hernia, recurrence following failed open repair and in hernia associated with undescended testis or ambiguous genitalia. On the other hand, open herniotomy appears to be advantageous in male inguinal hernia, unilateral female hernia, premature newborns, failed laparoscopic repair and in hernia associated with serious co-morbidity.
