小児鼠径ヘルニア修復術における開腹術と腹腔鏡下手術の周術期ストレスの比較：単一施設前向き研究の結果

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).

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.

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.

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.