Skip to main content
SpringerLink
Log in

Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to compare inflammatory stress response between laparoscopic percutaneous inguinal ring suturing (PIRS) and open modified Marcy technique for pediatric inguinal hernia repair.

Methods

From May 2017 to April 2018, 32 male children with median age of 4.5 years undergoing inguinal hernia repair were included in randomized controlled trial. The patients were divided in two groups, by using random number generator, depending on surgical approach. The blood was tested in three time frames for white blood cells count (WBC), C-reactive protein (CRP), Interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α).

Results

Significant increase in concentration for all inflammatory biomarkers, that occur over time, has been found (p < 0.001 for all). Additionally, it was also found that the type of surgery significantly influenced the level of WBC, CRP, and IL-6 with Marcy showing a higher level of inflammatory response (WBC 11.4 ± 3.1 × 109/L; CRP 11.5 mg/L; IL-6 11.0 pg/mL) than the PIRS (WBC 7.6 ± 1.6 × 109/L; CRP 0.8 mg/L; IL-6 2.0 pg/mL) (p < 0.001 for all). Similar pattern was also found for TNF-α (Marcy 16.8 pg/mL; PIRS 10.1 pg/mL), but correlation between surgery type and concentration of this biomarker was significant only at the 0.1 level (p = 0.055). The mean operation time was significantly shorter (9 ± 2 min) in PIRS group compared to Marcy group (25 ± 7 min) (p < 0.001). Significantly lower median of visual analog scale score (VAS) was found in PIRS group (VAS = 2) compared to Marcy group (VAS = 6) (p < 0.001).

Conclusions

Use of laparoscopic (PIRS) technique in children shows significantly lower surgical stress in comparison to open hernia repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pogorelić Z, Rikalo M, Jukić M, Katić J, Jurić I, Furlan D, Budimir D, Biočić M (2017) Modified Marcy repair for indirect inguinal hernia in children: a 24-year single-center experience of 6826 pediatric patients. Surg Today 47:108–113

    Article  Google Scholar 

  2. Thomas DT, Göcmen KB, Tulgar S, Boga I (2016) Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: experience with 250 cases. J Pediatr Surg 51:1330–1335

    Article  Google Scholar 

  3. Oral A, Karaca L, Ahiskalioglu A, Yildiz A, Yigiter M, Celikkaya ME, Chyndolotov T, Salman AB (2018) Effects of laparascopic hernia repair by PIRS (percutan internal ring suturing) technique on testicular artery blood supply. J Investig Surg 2:1–5

    Google Scholar 

  4. Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W (2006) Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 16:513–517

    Article  Google Scholar 

  5. Pogorelić Z (2018) Effects of laparascopic hernia repair by PIRS (percutaneous internal ring suturing) technique on testicular artery blood supply. J Investig Surg. https://doi.org/10.1080/08941939.2017.1423424

    Article  Google Scholar 

  6. Hao W, Chan IH, Liu X, Tang PM, Tam PK, Wong KK (2012) Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children. Pediatr Surg Int 28:281–286

    Article  Google Scholar 

  7. Hackam DJ, Rotstein OD (1998) Host response to laparoscopic surgery: mechanisms and clinical correlates. Can J Surg 41:103–111

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Song M, Kellum JA (2005) Interleukin-6. Crit Care Med 33:463–465

    Article  Google Scholar 

  9. Nast-Kolb D, Waydhas C, Gippner-steppert C, Schneider I, Trupka A, Ruchholtz S, Zettl R, Schweiberer L, Jochum M (1997) Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma 42:446–454

    Article  CAS  Google Scholar 

  10. Kragsbjerg P, Holmberg H, Vikerfors T (1995) Serum concentrations of interleukin-6, tumour necrosis factor-alpha, and C-reactive protein in patients undergoing major operations. Eur J Surg 161:17–22

    CAS  PubMed  Google Scholar 

  11. Toft P, Tonnesen E, Helbo-Hansen HS, Lillevang ST, Rasmussen JW, Christensen NJ (1994) Redistribution of granulocytes in patients after major surgical stress. APMIS 102:43–48

    Article  CAS  Google Scholar 

  12. Toft P, Tonnesen E (2008) The systemic inflammatory response to anaesthesia and surgery. Curr Anaesth Crit Care 19:349–353

    Article  Google Scholar 

  13. Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160

    Article  Google Scholar 

  14. Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML (1998) Laparoscopic evaluation of the pediatric inguinal hernia: a meta-analysis. J Pediatr Surg 33:874–879

    Article  CAS  Google Scholar 

  15. Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segawa H, Nakai Y, Mori K (1992) Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 77:426–431

    Article  CAS  Google Scholar 

  16. Novitsky YW, Litwin DE, Callery MP (2004) The net immunologic advantage of laparoscopic surgery. Surg Endosc 18:1411–1419

    Article  CAS  Google Scholar 

  17. van Berge Henegouwen MI, van der Poll T, van Deventer SJ, Gouma DJ (1998) Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications. Am J Surg 175:311–316

    Article  Google Scholar 

  18. Redmond HP, Watson WG, Houghton T, Condron C, Watson RG, Bouchier-Hayes D (1994) Immune function in patients undergoing open vs laparoscopic cholecystectomy. Arch Surg 129:1240–1246

    Article  CAS  Google Scholar 

  19. Özçınar B, Aksakal N, Yanar F, Ağcaoğlu O, Peker KD, Türkoğlu Ü, Mercan S, Özarmağan S, Erbil Y (2014) Increased interleukin 1 and tumor necrosis factor alpha levels after thyroid surgery. Ulus Cerrahi Derg 30:80–84

    PubMed  PubMed Central  Google Scholar 

  20. Mimica Ž, Pogorelić Z, Perko Z, Sršen D, Stipić R, Dujmović D (2007) Effect of surgical incision on pain and respiratory function after abdominal surgery: a randomized clinical trial. Hepatogastroenterology 54:2216–2220

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21 000, Split, Croatia

    Miro Jukić & Zenon Pogorelić

  2. School of Medicine, University of Split, Šoltanska 2, 21 000, Split, Croatia

    Zenon Pogorelić

  3. Department of Medical Laboratory Diagnostics, University Hospital of Split, Spinčićeva 1, Split, Croatia

    Daniela Šupe-Domić

  4. Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, Split, Croatia

    Ana Jerončić

Authors
  1. Miro Jukić
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zenon Pogorelić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Šupe-Domić
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Jerončić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miro Jukić.

Ethics declarations

Disclosures

Miro Jukić, Zenon Pogorelić, Daniela Šupe-Domić, and Ana Jerončić have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jukić, M., Pogorelić, Z., Šupe-Domić, D. et al. Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children. Surg Endosc 33, 3243–3250 (2019). https://doi.org/10.1007/s00464-018-06611-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-06611-y

Keywords

Search

Navigation