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Published on: November 12, 2021
Risks and benefits of pediatric inguinal hernia repair: Conventional open repair vs laparoscopic percutaneous
Masashi Kurobe1,2, Tetsuro Sugihara2, Atsushi Harada1
1Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan.
Insights
Laparoscopic percutaneous extraperitoneal closure (LPEC) and open repair (OR) are effective for pediatric inguinal hernias. LPEC prevents contralateral metachronous inguinal hernias but requires reducing umbilical port site complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Debate exists on laparoscopic percutaneous extraperitoneal closure (LPEC) versus conventional open repair (OR) for pediatric inguinal hernias (IH).
- Assessing outcomes and feasibility of LPEC compared to OR is crucial.
Purpose of the Study:
- To compare the outcomes and feasibility of LPEC versus OR in pediatric inguinal hernia repair.
- To evaluate recurrence rates, testicular complications, and contralateral metachronous IH (CMIH).
Main Methods:
- Retrospective analysis of 570 children undergoing LPEC or OR.
- Comparison of patient characteristics, operative time, complications, and CMIH incidence.
- Parental choice of operative method after informed consent.
Main Results:
- No significant differences in recurrence or testicular ascent between LPEC and OR.
- LPEC showed a significantly lower incidence of contralateral metachronous IH (CMIH) compared to OR (0% vs 4.1%).
- LPEC had more umbilical port site (UPS)-related complications, while OR had no surgical site infections.
Conclusions:
- Both LPEC and OR are feasible and effective for pediatric IH management.
- LPEC demonstrates superiority in preventing CMIH.
- Reducing UPS-related complications in LPEC is essential to maximize its benefits over OR.
Introduction:
Considerable debate exists regarding the benefits of laparoscopic percutaneous extraperitoneal closure (LPEC) over conventional open repair (OR). We assessed the outcomes and feasibility of LPEC compared to OR for pediatric inguinal hernia (IH).
Methods:
We retrospectively analyzed 570 children who underwent LPEC or OR. Parents decided the operative method after obtaining informed consent. Patient characteristics, operative time, complications and contralateral metachronous IH (CMIH) were compared between the groups.
Results:
A total of 329 children underwent LPEC and 241 underwent OR. There was no significant difference in the incidence of recurrence or testicular ascent between the LPEC and OR groups (0.3% vs 0.4%, P = 0.825, 0.3% vs 0.8%, P = 0.391, respectively). No testicular atrophy was recognized in either group. One patient with postoperative chronic inguinal pain was recognized in each group. There was no surgical site infection (SSI) in the OR group; however, the LPEC group more frequently demonstrated umbilical port site (UPS)-related complications, such as incisional hernia, minor deformity, granuloma formation, cellulitis and superficial SSI. Ten (4.1%) developed CMIH in OR; in contrast, no case of CMIH was experienced after LPEC (P < 0.001).
Conclusion:
In conclusion, both LPEC and OR are feasible in the management of pediatric IH, because of their high success rates and low risk of complications. LPEC could be the superior procedure with respect to the prevention of CMIH. However, to maximize the merits of LPEC over OR, it is important to reduce UPS-related complications in LPEC. A longer follow-up is needed to assess male fertility in patients who receive LPEC.
