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Preferences for Inguinal Hernia Repair in Infants: A Survey of the Eastern Pediatric Surgery Network
Zane J Hellmann1, J Leslie Knod2, Afif N Kulaylat3
1Division of Pediatric Surgery, Yale New Haven Children's Hospital, New Haven, Connecticut.
Insights
Early-career pediatric surgeons increasingly prefer laparoscopic inguinal hernia repair (IHR) in infants. This approach offers advantages like contralateral side assessment and technical ease over traditional open surgery.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- Laparoscopic inguinal hernia repair (IHR) is gaining traction in pediatric cases.
- Limited data exists on surgical practice patterns for infant IHR.
- This study investigates surgeon preferences for IHR in infants.
Purpose of the Study:
- To assess current pediatric surgeon preferences for laparoscopic versus open IHR in infants.
- To determine if early-career surgeons favor the laparoscopic approach.
- To identify factors influencing IHR strategy selection in infants.
Main Methods:
- A survey was distributed to 160 pediatric surgeons across 19 institutions.
- Surgeons were categorized by years of practice experience.
- Responses were analyzed using t-tests and chi-square tests.
Main Results:
- A 61% response rate was achieved with 98 valid responses.
- Over 90% of early-career surgeons preferred laparoscopic IHR.
- Laparoscopic preference decreased significantly with career progression (P < 0.001).
Conclusions:
- Early-career pediatric surgeons predominantly favor laparoscopic IHR for infants.
- This indicates a shift from the traditional open repair standard.
- Further research is needed to compare long-term outcomes of both IHR methods in infants.
Introduction:
Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population.
Methods:
A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate.
Results:
Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10 ys of experience, 26 (27.1%) had 10-20 ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P < 0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference.
Conclusions:
The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.
