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Published on: December 23, 2022
A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children
Michela Carter1, Steven T Papastefan2, Yao Tian1
1Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Northwestern Quality Improvement, Research and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Insights
Laparoscopic inguinal hernia repair in children shows higher recurrence rates but fewer repeat operations for new hernias compared to open repair. This study highlights trade-offs in surgical approaches for pediatric inguinal hernias.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Hernia Repair Techniques
Background:
- Laparoscopic inguinal hernia repair has seen increased adoption.
- Comparing outcomes between open and laparoscopic methods is crucial for pediatric care.
Purpose of the Study:
- To compare rates of second hernia operations and same-side recurrences between open and laparoscopic inguinal hernia repair in children.
- To analyze outcomes in a large national cohort.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System (PHIS) database (2017-2021).
- Inclusion of children under 18 undergoing primary inguinal hernia repair.
- Comparison of second operation and same-side recurrence rates using multivariable mixed-effects models, with sensitivity analyses for validation.
Main Results:
- Laparoscopic repair had a higher rate of same-side recurrence (1.5% vs. 0.4%, P < 0.001), persisting on multivariable analysis (OR 3.72).
- Laparoscopic repair showed a slightly higher, but not statistically significant on multivariable analysis, rate of second hernia operations (2.9% vs. 2.6%, P = 0.04).
- Sensitivity analyses confirmed the accuracy of the identified outcome rates.
Conclusions:
- Laparoscopic inguinal hernia repair in children is associated with over three times the odds of same-side recurrence compared to open repair.
- However, laparoscopic repair is linked to a reduced rate of second operations for metachronous hernias, indicating a trade-off in outcomes.
Background:
Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.
Methods:
This retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates.
Results:
We identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p = 0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p < 0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS.
Conclusion:
Laparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia.
Level Of Evidence:
Treatment Study - Level III.
