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Should the processus vaginalis sac be opened or closed in pediatric herniotomy? A two-center cohort study
Veronika Michler1, Julia Elrod1,2, Kristofer Wingtes1
1Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Closed hernia sac preparation is faster and reduces recurrence in pediatric inguinal hernia repair. This technique is recommended for premature neonates, neonates, and older children, offering improved outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Hernia Repair
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Optimal surgical techniques for hernia sac preparation remain under investigation.
- The superiority of open versus closed hernia sac preparation in neonates and children is not well-established.
Purpose of the Study:
- To compare the efficacy of open versus closed hernia sac preparation techniques in pediatric inguinal hernia repair.
- To evaluate the impact of surgical technique on operative time, complications, and recurrence rates.
- To determine the optimal technique for different pediatric age groups, including premature neonates.
Main Methods:
- Retrospective analysis of 2257 pediatric inguinal hernia repair cases from two major centers.
- Exclusion of direct hernias and revision cases; propensity score matching for technique comparison.
- Regression analysis to identify factors influencing operative time and recurrence.
Main Results:
- Closed preparation technique demonstrated significantly shorter procedure times and lower recurrence rates compared to open preparation.
- Operative technique, prematurity, gender, and surgeon's training impacted operative time.
- Operative technique was the primary determinant of recurrence rate.
Conclusions:
- Closed hernia sac preparation is superior to open preparation in terms of speed and recurrence rates for pediatric inguinal hernia repair.
- This advantage was observed across premature neonates, neonates, and older children.
- Intraoperative and postoperative complication rates were similar between the two techniques.
Background:
Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children.
Methods:
Retrospective study including all cases of inguinal hernia repair in children at two large centers. Demographic data and outcome parameters including procedure time and intra as well as postoperative complications were evaluated. To compare open vs. closed hernia sack preparation, cases with secondary open preparation were excluded and propensity score matching was performed. Regression analysis was used to determine factors affecting operative time and recurrence rate.
Results:
In total 2476 cases of inguinal hernia repair were identified. After exclusion of direct hernias as well as revision cases, 2257 cases were analyzed. Overall mean operative time was 25.8 min. Intraoperative complications occurred in 0.1% and. postoperative complications occurred in 3.0% of all cases, the most frequent postoperative complication being recurrence (1.7%). Closed preparation technique resulted in significantly faster procedure time and lower recurrence rates in premature neonates and older children compared to the open hernia sac preparation technique. Operative technique, prematurity, gender and training of the surgeon are highly associated with operative time, whereas operative technique is the main factor affecting recurrence rate.
Conclusions:
It appears that closed hernia sack preparation is superior to open regarding speed and recurrence. This was true for premature neonates, neonates and older children. All other outcome parameters including intra- and postoperative complications were similar. Thus, we recommend to use the closed preparation technique whenever possible.
