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Is the open approach superior to the laparoscopic hernia repair in children? A retrospective comparative study
Raed N Al-Taher1, Ibrahim A Khrais1, Suhib Alma'aitah1
1Department of General Surgery, Division of Pediatric Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
Insights
Pediatric inguinal hernia repair outcomes show laparoscopy offers faster recovery and shorter operative times for bilateral cases. Cosmetic results were comparable between open and laparoscopic approaches in this study.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Surgical outcomes
Background:
- Inguinal hernia repair in children is commonly performed via open or laparoscopic techniques.
- Laparoscopy offers advantages in cosmesis and reduced postoperative pain.
- Recent literature suggests a potential return to open repair due to comparable outcomes and lower costs.
Purpose of the Study:
- To compare the outcomes of open versus laparoscopic inguinal hernia repair in pediatric patients.
- To evaluate operative time, postoperative complications, recovery time, and cosmetic results.
Main Methods:
- Retrospective analysis of prospectively collected data.
- Inclusion of patients aged 6 months to 13 years undergoing inguinal hernia repair.
- Study period: January 2017 to July 2019.
Main Results:
- 155 patients included: 100 open (64.5%) and 55 laparoscopic (35.5%).
- No significant difference in overall postoperative complications (P=0.66).
- Laparoscopy showed shorter operative time for bilateral hernias (44 vs. 63.2 min, P=0.049) and faster full recovery (4.7 vs. 7.5 days, P=0.013).
- Cosmetic outcomes were similar between groups, contrary to existing literature.
Conclusions:
- Laparoscopic inguinal hernia repair is feasible and reproducible in children.
- Laparoscopy allows contralateral groin evaluation without additional incisions.
- Laparoscopy demonstrated superiority in operative time for bilateral hernias and time to recovery.
- Laparoscopy provides enhanced training opportunities for surgical residents.
Background:
For many years now, inguinal hernia repair in children has been done either by the open approach or laparoscopically with laparoscopy having the edge in terms of cosmesis and postoperative pain. However, recent studies have called for a return of the open approach as it had a comparable result to laparoscopy with lesser cost. This study aims to compare the outcomes of the two approaches at our institution.
Methods:
This is a retrospective analysis of the prospectively collected data of all patients aged between 6 months and 13 years who underwent open or laparoscopic inguinal hernia repair in the period between January 2017 and July 2019 at our institution.
Results:
155 patients were included in the study. 100 (64.5%) underwent open inguinal repair while 55 (35.5%) were done laparoscopically. There was no significant difference in the postoperative complications between the open and laparoscopic groups (P = 0.66). The overall mean operative time for the laparoscopic group and the open group is (45.7 ± 15.2, 45.5 ± 15.4 min, P = 0.83) respectively. However, a subgroup analysis showed a statistical difference in the operative time in bilateral hernias favoring the laparoscopic approach, (44 ± 13.2, 63.2 ± 26.4 min respectively, P = 0.049). Laparoscopy was also associated with shorter times to full recovery compared to the open group (4.7 days, 7.5 days, P = 0.013). Surprisingly, there was no difference in the cosmetic outcome between the two groups which is contrary to the published literature.
Conclusions:
Laparoscopic inguinal hernia repair in children is a feasible and reproducible procedure. It permits the evaluation of the contralateral groin without further incisions. In our study, laparoscopy was superior in terms of operative time in bilateral hernias and the time to recovery. Finally, an added benefit to laparoscopy is that it offers more training opportunities for fellows and residents to improve their laparoscopic skills.
