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Variations in open and laparoscopic repair of paediatric inguinal hernia
Christoffer Skov Olesen1, Kristoffer Andersen, Stina Öberg
1christofferskovolesen@gmail.com.
Insights
Surgical repair of pediatric inguinal hernias shows significant technique variations among Danish surgeons. Further research is needed to standardize procedures and improve care quality for children with inguinal hernias.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Hernia Repair
Background:
- Lack of current guidelines for pediatric inguinal hernia repair.
- International disagreement on preferred surgical approaches and techniques.
- Need to assess current surgical practices in Denmark.
Purpose of the Study:
- To survey Danish surgeons on their techniques for pediatric inguinal hernia repair.
- To identify variations in open and laparoscopic repair methods.
- To understand age-specific surgical approaches for children.
Main Methods:
- Nationwide survey of all surgeons performing pediatric inguinal hernia repair in Denmark.
- Questionnaire included demographic data, approach choice (open vs. laparoscopic), and technical details.
- Surgical details were queried for three pediatric age groups: <2, 2-12, and 13-18 years.
Main Results:
- 81% response rate from 59 surgeons.
- Majority used open repair for children ≤12 years; laparoscopic repair was not exclusively used by any surgeon.
- For adolescents (13-18 years), two-thirds used open repair only, 6% used laparoscopic only, and the remainder used both.
- Significant variations observed in open and laparoscopic repair details, including fascial incision, nerve identification, and contralateral exploration.
Conclusions:
- Considerable variation exists in pediatric inguinal hernia repair techniques across different age groups.
- Need for research to rationalize and update guidelines for pediatric inguinal hernia repair.
- Standardization of surgical techniques may improve quality of care and facilitate future research.
Introduction:
No recent guidelines exist for surgical treatment of paediatric inguinal hernias. Internationally, there is disagreement about both the preferred approach and the details of the surgical procedure. The aim of this nationwide survey study was to assess variations in Danish surgeons' technique when repairing inguinal hernias in children.
Methods:
A questionnaire was sent to all surgeons in Denmark performing paediatric inguinal hernia repair, including questions about demographic details, choice of open or laparoscopic repair, and technical details of the chosen surgical approach. In the questionnaire, each item was repeated for children aged les than 2, 2-12, and 13-18 years of age.
Results:
In total, 48 of 59 surgeons responded (81%). For children 12 years of age, the majority of surgeons only performed open repair, whereas none performed laparoscopic repair only. For children aged 13-18 years of age, two thirds of the surgeons performed open repair only, 6% performed laparoscopic repair only and the rest used both methods. We found considerable variations in the execution of both open and laparoscopic repair. The variations regarded incision of the external fascia, nerve identification, division of the cremaster muscle, and exploration of the contralateral groin and repair of an asymptomatic hernia.
Conclusions:
This study found considerable variation in the execution of both open and laparoscopic repair of inguinal hernias in children of different age groups. Research into inguinal hernia repair in children is needed to rationalise and update guidelines in order to improve quality and facilitate research.
Funding:
none.
Trial Registration:
not relevant.
