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Open and laparoscopic inguinal hernia repair in children: A regional experience
Nadia Safa1, Annie Le-Nguyen2, Rana Gaffar1
1Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Room B04.2028, Montréal, QC H4A 3J1, Canada.
Insights
Laparoscopic inguinal hernia repair in children reduces metachronous hernias but significantly increases recurrence rates compared to open repair. This study highlights a critical trade-off in pediatric surgical approaches.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- The optimal surgical technique for pediatric inguinal hernias remains a subject of ongoing debate.
- Assessing recurrence and metachronous hernia rates is crucial for evaluating different surgical approaches.
Purpose of the Study:
- To compare recurrence and metachronous hernia rates between open repair (OPEN) and laparoscopic repair (LAP) in pediatric patients.
- To analyze outcomes of pediatric inguinal hernia repair over a 5-year period.
Main Methods:
- A retrospective cohort study involving 1,952 pediatric patients (<14 years) undergoing inguinal hernia repair.
- Analysis of data from two children's hospitals over a 5-year period (2011-2015) with a minimum 4-year follow-up.
- Cox proportional regression was used to compare surgical approaches regarding recurrence and metachronous hernias.
Main Results:
- Laparoscopic repair (LAP) was associated with a lower incidence of metachronous contralateral hernias (1.4% vs. 3.8%, p=0.047).
- Open repair (OPEN) demonstrated a significantly lower recurrence rate (0.9% vs. 9%, p<0.001).
- Adjusted analysis revealed LAP had a substantially higher recurrence rate (Hazard Ratio 10.4).
Conclusions:
- Pediatric laparoscopic inguinal hernia repair offers a modest reduction in metachronous hernias.
- This benefit comes at the significant cost of a substantially increased hernia recurrence rate compared to open repair.
Purpose:
The optimal approach for pediatric inguinal hernia repair continues to be debated. We conducted a regional retrospective study to assess rates of recurrence and metachronous hernias after open repair (OPEN) and laparoscopic repair (LAP) METHODS: A retrospective cohort study was conducted at two children's hospitals that serve a region of approximately 4 million people. All patients < 14 years old undergoing OPEN or LAP by pediatric surgeons during a 5-year period (2011 - 2015) were analyzed after a minimum follow up of 4 years. Cox proportional regression was used to compare the effect of surgical approach on hernia recurrence and metachronous contralateral hernias.
Results:
A total of 1,952 patients, 587 female (30%) and 1365 male (70%), had 2305 hernias repaired. Median post operative follow up time was 6.6 years (range 4-9 years). OPEN and LAP were performed for 1827 (79%) and 478 (21%) hernias, respectively. There were no significant differences in rate of prematurity, age at repair, or frequency of emergent repair. LAP was associated with a lower incidence of metachronous contralateral hernias compared to OPEN (1.4% vs 3.8%, p = 0.047), and a higher incidence of recurrence (9% vs 0.9%, p < 0.001). After adjusting for confounders, LAP had a higher rate of recurrence than OPEN (hazard ratio 10.4, 95% CI 6-18.1).The recurrence rate did not decrease over the study period (p = 0.731).
Conclusion:
Laparoscopic inguinal hernia repair in children resulted in a modest decrease in the incidence of metachronous hernias, at the cost of a significant increase in recurrence.
Type Of Study:
Retrospective Comparative Study.
Level Of Evidence:
Level III.
