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Published on: January 7, 2019
Effect of a Pediatric Surgeon's Primarily Performed Technique on Inguinal Hernia Recurrence Rates: A Multicenter
Kathleen Heller1, Brielle V Ochoa1, Stephanie Brierley1
1Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, AZ, USA.
Insights
Pediatric surgeons preferring open hernia repair had higher recurrence rates when performing laparoscopic inguinal hernia repair. Laparoscopic surgeons showed no difference in recurrence rates between open and laparoscopic repairs.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Hernia Repair Techniques
Background:
- Inguinal hernia repair (IHR) is a common pediatric surgical procedure.
- Surgeon preference for either open or laparoscopic techniques is a key factor in surgical practice.
Purpose of the Study:
- To evaluate the impact of surgeons' preferred technique (open vs. laparoscopic) on pediatric inguinal hernia recurrence rates.
- To compare recurrence rates based on surgeon specialization in open or laparoscopic IHR.
Main Methods:
- Multicenter retrospective cohort study of pediatric patients (<18 years) undergoing IHR.
- Data collected from 21 children's hospitals between 2017-2019 with 3-year follow-up.
- Surgeons classified as 'Open' or 'Laparoscopic' based on ≥70% preference for a technique.
Main Results:
- Open surgeons demonstrated higher recurrence rates (3.6%) for laparoscopic IHR compared to their open IHR (0.9%).
- Laparoscopic surgeons showed similar recurrence rates for both open (1.7%) and laparoscopic (1.7%) IHR.
- No significant difference in recurrence rates for open IHR between Open and Laparoscopic surgeons (0.9% vs. 1.7%).
Conclusions:
- Surgeons with a preference for open repair exhibit increased recurrence rates when performing laparoscopic inguinal hernia repair.
- Laparoscopic surgeons achieve comparable recurrence rates regardless of the chosen IHR approach.
- Pediatric surgeons should ensure proficiency in both open and laparoscopic techniques to minimize recurrence.
Purpose:
To investigate the effect of surgeons' preferred repair technique for pediatric inguinal hernia repair (IHR) -laparoscopic versus open-on hernia recurrence rates.
Methods:
We conducted a multicenter retrospective cohort study of patients aged <18 years old who underwent IHR at 21 children's hospitals from 2017 to 2019 with 3 year follow up. Surgeons preferring open hernia repair performed ≥70 % of hernia repairs open (Open surgeons). Surgeons preferring laparoscopic hernia repair performed ≥70 % of hernia repairs laparoscopically (Laparoscopic surgeons). Descriptive statistics and multivariable regression were utilized.
Results:
Among 207 surgeons, 125 (60.4 %) were Open surgeons, and of those 54 (43.2 %) performed at least 1 laparoscopic IHR. The inguinal hernia recurrence rates for Open surgeons were 0.9 % for open IHR and 3.6 % for laparoscopic IHR, p < 0.001. There were 58 (28.0 %) Laparoscopic surgeons and of those 44 (75.9 %) performed at least 1 open IHR. The inguinal hernia recurrence rates for Laparoscopic surgeons were 1.7 % for laparoscopic IHR and 1.7 % for open IHR, p = 1.000. For open IHR, no significant difference in recurrence rates was observed between Open and Laparoscopic surgeons (0.9 % versus 1.7 %, p = 0.230). For laparoscopic inguinal hernia repairs, Open surgeons had higher recurrence rates than Laparoscopic surgeons with odds ratio of (3.6 % versus 1.7 %, p = 0.019).
Conclusions:
Open surgeons have higher inguinal hernia recurrence rates when performing laparoscopic IHR. No difference in hernia recurrence rates following open and laparoscopic repair was noted for Laparoscopic surgeons. Pediatric surgeons dividing cases between open and laparoscopic IHR should take caution to maintain adequate proficiency in both.
