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Age-stratified outcomes after laparoscopic inguinal hernia repair in children: A large single-center cohort study
Bingran Yu1, Shuan Liu2, Zai Song2
1Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects, Shanghai, China.
Insights
Laparoscopic inguinal hernia repair (LIHR) in infants under 6 months shows higher risks of incarceration and bilateral disease. Recurrence after LIHR is low overall but increases with age, necessitating age-specific care.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Age-related differences in presentation and outcomes of laparoscopic inguinal hernia repair (LIHR) are not fully understood.
- Evaluating age-stratified perioperative characteristics and recurrence after LIHR is crucial for optimizing pediatric care.
Purpose of the Study:
- To analyze age-stratified outcomes and recurrence rates following laparoscopic inguinal hernia repair in children.
- To identify age-specific risk factors and inform tailored surgical approaches and follow-up strategies.
Main Methods:
- Retrospective single-center cohort study of 8,941 children undergoing LIHR.
- Patients were stratified into five age groups: <6 months, 6-12 months, 1-2 years, 2-5 years, and >5 years.
- Primary outcome was recurrence; secondary outcomes included incarceration, hernia laterality, operative time, occult contralateral hernia, conversion, complications, and length of stay.
Main Results:
- Incarceration and bilateral hernia rates were highest in infants <6 months (15.6% and 74.6%, respectively).
- Occult contralateral hernias were most common in the <6 months group (52.7%), and operative time and conversion rates decreased with age.
- Overall recurrence was 1.3%, absent in <6 months, and increased to 2.1% in the >5 years group. Male sex and unilateral presentation predicted recurrence.
Conclusions:
- Infants, particularly those <6 months, experience higher rates of incarceration, bilateral disease, and operative complexity during LIHR.
- Overall recurrence rates after LIHR are low, but increase with age, highlighting the need for age-stratified counseling, surgical planning, and follow-up.
Background:
Age-related differences in presentation and outcomes after laparoscopic inguinal hernia repair (LIHR) remain incompletely characterized. We evaluated age-stratified perioperative characteristics and recurrence after LIHR.
Methods:
We conducted a retrospective single-center cohort study of consecutive children undergoing LIHR, stratified as <6 months, 6-12 months, 1-2 years, 2-5 years, and >5 years. The primary outcome was recurrence, while secondary outcomes included incarceration, hernia laterality, operative time, occult contralateral hernia detection, conversion to open surgery, complications, and length of stay.
Results:
Among 8941 children, incarceration occurred in 2.1%, bilateral hernia in 47.6%, and occult contralateral hernia was detected in 39.2%. Incarceration decreased with age (15.6% in <6 months vs 0.6-0.7% in >2 years; P < 0.001), and bilateral hernia was most frequent in <6 months (74.6%; P < 0.001). Median operative time decreased from 31 min (<6 months) to 26 min (>5 years; P < 0.001). Occult contralateral hernia was most common in <6 months (52.7%; P < 0.001). Conversion was highest in <6 months (0.8%) and absent in >5 years (P = 0.009). Recurrence was 1.3% (113/8941), with none in <6 months and increasing to 2.1% in >5 years (P < 0.001). Male sex (HR 2.974, 95% CI 1.708-5.176) and unilateral presentation (HR 5.141, 95% CI 2.931-9.017) independently predicted recurrence.
Conclusions:
Infants, especially those <6 months, had higher rates of incarceration and bilateral disease, more frequent occult contralateral findings, and greater operative complexity. Recurrence after LIHR was low overall, absent in <6 months, and increased with age, supporting age-stratified counseling, operative planning, and follow-up.
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