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Recurrence following laparoscopic repair of bilateral inguinal hernia in children under five
Gwyneth A Sullivan1, Nicholas J Skertich1, Russel Herberg1
1Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA.
Insights
Laparoscopic inguinal hernia repair in children under five showed higher recurrence rates compared to open repair nationally. This finding highlights potential differences in long-term outcomes for pediatric inguinal hernia treatment.
Area of Science:
- Pediatric surgery
- Surgical outcomes research
- Hernia repair epidemiology
Background:
- Previous studies on inguinal hernia repair recurrence rates often lack long-term follow-up and are limited to high-volume surgical centers.
- A national comparison of recurrence rates between laparoscopic and open bilateral inguinal hernia repair is needed to inform clinical practice.
- Understanding recurrence patterns is crucial for optimizing surgical techniques and patient management in pediatric populations.
Purpose of the Study:
- To compare national recurrence rates following laparoscopic versus open bilateral inguinal hernia repair in children.
- To evaluate the long-term outcomes associated with different surgical approaches for pediatric inguinal hernias.
- To identify factors influencing hernia recurrence in young children undergoing repair.
Main Methods:
- A national cohort of children under five undergoing bilateral inguinal hernia repair between 2010 and 2020 was identified.
- Data were extracted from the PearlDiver Mariner database for analysis.
- Time to recurrence was assessed using Kaplan-Meier analysis and Cox proportional hazards regression models.
Main Results:
- A total of 8,367 children were included, with 182 (2.2%) experiencing hernia recurrence requiring reoperation.
- The rate of recurrence was significantly higher after laparoscopic repair compared to open repair (1-year: 2.8% vs. 1.5%; 3-year: 3.7% vs. 2.0%; p < 0.01).
- This disparity persisted after adjusting for demographic and operative factors, with an adjusted hazard ratio of 2.00 (95% CI: 1.31, 3.05) for laparoscopic repair.
Conclusions:
- Laparoscopic repair of bilateral inguinal hernias in children under five is associated with a higher risk of recurrence compared to open repair.
- These national findings suggest a need for further investigation into the underlying causes of increased recurrence with laparoscopic techniques in this age group.
- The results emphasize the importance of considering surgical approach when managing pediatric inguinal hernias to minimize recurrence.
Background:
Reported recurrence rates after laparoscopic versus open inguinal hernia repair have been limited to high volume centers with short follow-up. We sought to compare national rates of recurrence after laparoscopic versus open bilateral inguinal hernia repair.
Methods:
Children under five who underwent bilateral inguinal hernia repair between 2010 and 2020 were identified using the PearlDiver Mariner database. Time to recurrence was compared using Kaplan Meier analysis and Cox proportional hazards regression models.
Results:
Hernia recurrence requiring reoperation occurred in 182 (2.2%) of 8,367 children. Rate of recurrence was higher following laparoscopic repair compared to open (1-year: 2.8% vs. 1.5%; 3-year: 3.7% vs. 2.0%; p < 0.01). This difference remained after adjustment for demographic and operative characteristics (adjusted hazard ratio [aHR]: 2.00 [95% confidence interval [CI]: 1.31, 3.05]).
Conclusions:
Risk of recurrence was higher after laparoscopic compared to open repair of bilateral inguinal hernia repair in a national cohort of children under age five.
