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Published on: November 12, 2021
Outcome Of Laparoscopic Percutaneous Extra Peritoneal Closure Versus Open Repair For Paediatric Inguinal Hernia
Armaghan Ahmed1, Imran Hashim1, Farrakh Mehmood1
1Children Hospital and University of Child Health, Lahore, Pakistan.
Insights
Laparoscopic percutaneous extra-peritoneal closure (LPEC) is superior to open repair for pediatric inguinal hernias, significantly reducing contralateral hernias and operative time with similar recurrence rates.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair (LIHR) offers advantages over open repair, including fewer metachronous contralateral hernias, reduced complications, shorter operation duration, and better cosmetic outcomes.
- The study addresses the need for comparative outcome data between LIHR techniques and open repair in pediatric patients.
Purpose of the Study:
- To compare the outcomes of laparoscopic percutaneous extra-peritoneal closure (LPEC) versus conventional open repair for pediatric inguinal hernias.
- Key outcome measures include the incidence of contralateral metachronous hernias, operative time, and hernia recurrence rates.
Main Methods:
- A randomized controlled trial involving 296 pediatric patients with inguinal hernias.
- Patients were randomized into two groups: conventional open repair (Group 1) and laparoscopic percutaneous extra-peritoneal closure (LPEC) (Group 2).
- Data on operative time, contralateral metachronous hernia, and recurrence were collected and analyzed using SPSS, with statistical significance set at p ≤ 0.05.
Main Results:
- The mean operative time was significantly shorter in the LPEC group (24.79±3.44 minutes) compared to the open repair group (28.71±4.54 minutes) (p < 0.001).
- The incidence of contralateral metachronous hernias was substantially lower in the LPEC group (1.4%) versus the open repair group (12.8%) (p < 0.001).
- Recurrence rates were low in both groups (LPEC: 0.7%, Open: 2.7%), with no statistically significant difference (p > 0.05).
Conclusions:
- Laparoscopic percutaneous extra-peritoneal closure (LPEC) demonstrates superior outcomes compared to conventional open repair for pediatric inguinal hernias.
- LPEC significantly reduces the occurrence of contralateral metachronous hernias and shortens operative time.
- The LPEC technique offers comparable recurrence rates to open repair, making it a favorable surgical option.
Background:
Laparoscopic inguinal hernia repair (LIHR) has many benefits like less frequency of metachronous contralateral hernias, minimum complications, comparatively less duration of operation and better cosmetic outcome as compared to the open technique. Objective of the study was to compare the outcome of laparoscopic percutaneous extra-peritoneal closure (LPEC) and open repair for paediatric inguinal hernia in terms of contralateral metachronous hernia, operative time and recurrence.
Methods:
A randomized controlled trial was conducted at the Department of Paediatric Surgery, Children Hospital Lahore. Non-probability purposive sampling was used, and 296 cases were divided into group-1(managed with conventional open repair) and group-2 (managed with laparoscopic Percutaneous Extra-peritoneal closure). After taking informed consent, data was collected, and cases were studied for operative time, contralateral metachronous hernia and recurrence till 6 months postoperatively. Data analysis was done through SPSS 22.0. Chi-square and independent sample t-test was used for comparison. p-value ≤0.05 was taken as significant.
Results:
The mean operative time was statistically less in the LPEC group (24.79±3.44 minutes) when compared to the open repair group (28.71±4.54 minutes), p-value <0.001. In the Open repair group, there were 19 (12.8%) cases that had contralateral metachronous hernia, while in the LEPC group, 2 (1.4%) cases had contralateral metachronous hernia p-value <0.001. In the Open repair group, 4(2.7%) cases had a recurrence, while in LPEC group 1 (0.7%) cases had a recurrence, with statistically same recurrence rate, p-value >0.05.
Conclusions:
The LPEC technique is better than conventional open repair in terms of CMIH, operative time, and recurrence rate.
