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Published on: November 12, 2021
Comparing Surgical Stress in Children Undergoing Open and Laparoscopic Inguinal Hernioplasty-A Single Center's
Charikleia Demiri1, Ioannis Spyridakis1, Stavros Iliadis2
1Second Department of Paediatric Surgery, Papageorgiou General Hospital of Thessaloniki, "Aristotle" University Medical School, Ring Road of Thessaloniki, St Paul Area, 56429 Thessaloniki, Greece.
Insights
Pediatric inguinal hernioplasty using open (OIH) or laparoscopic (LIH) methods shows similar impacts on inflammatory and endocrine stress markers. Laparoscopic inguinal hernioplasty (LIH) is a safe alternative to open repair, with comparable operative stress in children.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Stress Response
Background:
- Inguinal hernioplasty is a common pediatric procedure.
- The impact of surgical approach on perioperative stress is not fully understood.
- Comparing open (OIH) and laparoscopic (LIH) inguinal hernioplasty is crucial.
Purpose of the Study:
- To compare early inflammatory and endocrine stress markers after OIH and LIH in children.
- To evaluate the safety and effectiveness of LIH as an alternative to OIH.
- To assess operative stress differences between the two surgical methods.
Main Methods:
- Prospective observational study with 1:1 allocation (2021-2023).
- Included otherwise healthy children undergoing elective unilateral indirect inguinal hernia repair.
- Measured white blood cells, cortisol, MDA, ferritin, albumin, and CRP at five time points.
Main Results:
- Thirty-two children (mean age 3.8 years) were randomized.
- Operative times were longer for LIH (1h 7m) vs. OIH (41m) (p < 0.01).
- No significant differences in CRP, cortisol, MDA, albumin, or ferritin; WBC showed an earlier rise post-LIH (p=0.006).
Conclusions:
- LIH and OIH have comparable impacts on the pediatric inflammatory response.
- LIH is a safe and effective alternative to OIH regarding operative stress.
- Further research is needed to validate findings and assess long-term implications.
Background:
Inguinal hernioplasty in the pediatric population is a common minor injury operation. Whether the surgical approach alters perioperative stress responses remains uncertain. The aim of this study was to compare early inflammatory and endocrine stress markers after open (OIH) and laparoscopic inguinal hernioplasty (LIH).
Methods:
A single-center prospective observational study with 1:1 allocation between 2021 and 2023. Otherwise healthy children, scheduled for elective unilateral indirect inguinal hernia repair, were assigned to open or laparoscopic hernioplasty. Blood samples were collected at five time points, measuring levels of white blood cells, cortisol, MDA, ferritin, albumin, and CRP. Analyses used two-way repeated measures ANOVA with Greenhouse-Geisser correction and Bonferroni-adjusted planned contrasts at 24 h.
Results:
Thirty-two children aged from 2.4 months to 11 years with a mean age of 3.8 years (± 2.46 Standard Deviation, SD) were randomized equally. Operative times were longer in the laparoscopic group [01:07 (±00:20-SD)]; [open group operative duration: 00:41 (±00:16-SD), (p < 0.01)]; discharge on postoperative day 1 was universal. The group × time interaction was not significant for CRP, cortisol, MDA, albumin, or ferritin. WBC showed a modest interaction consistent with an earlier postoperative rise after laparoscopy (p = 0.006). No surgical site infections or recurrences occurred over a 2-year follow-up.
Conclusions:
This study demonstrates that LIH and OIH in children have a comparable impact on the inflammatory response. LIH is a safe and effective alternative to the traditional open repair method regarding operative stress. To validate these findings and assess the long-term implications of each surgical approach on children's pathophysiology, further research is warranted.
