Prospective randomized single-center, single-blind Comparison of laparoscopic vs open repair of pediatric inguinal hernia

Original article

Abstract

Background

The repair of indirect inguinal hernia (IH) is one of the most common pediatric surgical procedures, and open surgery (OS) is the standard treatment. The aim of this study was to determine whether the recently developed laparoscopic repair (LR) of IH is superior to OS.

Methods

Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients at our institution into OS and LR groups. Fourteen pateints were excluded from the study for various reasons, leaving study population of 83 patients. After operation, multiple dressings were placed to blind observers to the operation type. Two pain scales, the children and Infants Postoperative Pain were used to assess postoperative pain. Acetaminophen (15 mg/kg/dose every 6 h) was given at a fixed pain score. Analgesic doses were compared. Parents also provided assessments of their children’s recovery and wound appearance.

Results

The amount of acetaminophen taken by the OS group (n = 42) was 1.05 ± 1.248 doses per patient, whereas the amount taken by the LR group (n = 41) was 0.54 ± 0.84 dose per patient (p = 0.032; 95% confidence interval 0.45–0.976). Laparoscopy detected 11 more bilateral hernias (p = 0.006). Although the operative times did not differ significantly for bilateral hernias (39.08 ± 13.37 min vs 34.0 ± 11.31 min, p = 0.623), it did differ for unilateral hernias (18.38 ± 5.71 vs 23.25 ± 6.26 min, p = 0.001). Five contralateral hernias were detected in the OS group on follow-up, but none were found in the LR group (p = 0.026). The scores given by parents for recovery and wound appearance were higher in the LR group (p = 0.05).

Conclusions

As compared with IH patients who undergo open surgery, those who have a laparoscopic repair suffer less pain, and their recovery and wound cosmesis are more satisfactory. With LR, contralateral hernias can be detected and repaired in a single operative procedure. This procedure takes slightly longer for unilateral than for bilateral hernias.

Keywords

Laparoscopy Hernia repair Pediatric surgery Pain Cosmesis 

References

  1. 1.
    Buttner, W, Finke, W 2000Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studiesPaediatr Anaesth10303318CrossRefPubMedGoogle Scholar
  2. 2.
    Carneiro, PM 1990Inguinal herniotomy in childrenEast Afr Med J67359364PubMedGoogle Scholar
  3. 3.
    Chan, KL, Tam, PKH 2003A safe laparoscopic technique for the repair of inguinal hernias in boysJ Am Coll Surg196987989CrossRefPubMedGoogle Scholar
  4. 4.
    Chan, KL, Tam, PKH 2004Technical refinements in laparoscopic repair of childhood inguinal herniaSurg Endosc18957960CrossRefPubMedGoogle Scholar
  5. 5.
    Davis, CJ, Arregui, ME 2003Laparoscopic repair for groin herniasSurg Clin North Am8311411161CrossRefPubMedGoogle Scholar
  6. 6.
    Ehrlich, PF, Newman, KD, Haase, GM, Lobe, TE, Wiener, ES, Holcomb, GW 2002Lessons learned from a failed multi-institutional randomized controlled studyJ Pediatr Surg37431436CrossRefPubMedGoogle Scholar
  7. 7.
    Geisler, DP, Jegathesan, S, Parmley, MC, McGee, JM, Nolen, MG, Broughan, TA 2001Laparoscopic exploration for the clinically undetected hernia in infancy and childhoodAm J Surg182693696CrossRefPubMedGoogle Scholar
  8. 8.
    Grosfeld, JL, Minnick, K, Shedd, F, West, KW, Rescoria, FJ, Vane, DW 1991Inguinal hernia in children: factors affecting recurrence in 62 casesJ Pediatr Surg26283287CrossRefPubMedGoogle Scholar
  9. 9.
    Harvey, MH, Johnstone, MJ, Fossard, DP 1985Inguinal herniotomy in children: a five year surveyBr J Surg72485487PubMedGoogle Scholar
  10. 10.
    Laberge, JM 2002What’s new in pediatric surgery?J Am Coll Surg195208218CrossRefPubMedGoogle Scholar
  11. 11.
    Lau, WY 2002History of treatment of groin herniaWorld J Surg26748759CrossRefPubMedGoogle Scholar
  12. 12.
    Levitt, MA, Ferraraccio, D, Arbesman, MC, Brisseau, GF, Caty, MC, Glick, PL 2002Variability of inguinal hernia surgical technique: a survey of North American pediatric surgeonsJ Pediatr Surg3745751CrossRefGoogle Scholar
  13. 13.
    Lyon, F, Dawson, D 2003Oucher or CHEOPS for pain assessment in childrenEmerg Med J20470CrossRefPubMedGoogle Scholar
  14. 14.
    Majeed, AW, Troy, G, Nicholl, JP,  et al. 1996Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomyLancet347989994CrossRefPubMedGoogle Scholar
  15. 15.
    McCormack K, Scott NW, Go PM, et al. (2003) Laparocopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785Google Scholar
  16. 16.
    McGrath, PJ, Johnson, G, Goodman, JT,  et al. 1985CHEOPS: a behavioral scale for rating postoperative pain in childrenPain Res Ther9395402Google Scholar
  17. 17.
    Montupet, P, Esposito, C 1999Laparoscopic treatment of congenital inguinal hernia in childrenJ Pediatr Surg34420423CrossRefPubMedGoogle Scholar
  18. 18.
    Prasad, R, Lovvorn, HN,III, Wadle, GM, Lobe, TE 2003Early experience with needleoscopic inguinal hemiorhaphy in childrenJ Pediatr Surg3810551058CrossRefPubMedGoogle Scholar
  19. 19.
    Schier, F 1998Laparoscopic hemiorrhaphy in girlsJ Pediatr Surg3314951497CrossRefPubMedGoogle Scholar
  20. 20.
    Schier, F 2000Laparoscopic surgery of inguinal hernias in children – initial experienceJ Pediatr Surg3513311338CrossRefPubMedGoogle Scholar
  21. 21.
    Schier, F, Montupet, P, Esposito, C 2002Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairsJ Pediatr Surg37395397CrossRefPubMedGoogle Scholar
  22. 22.
    Shawn, JR, Marion, CWH, Brindle, M, Moss, RL 2003Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapiesJ Pediatr Surg3814291433CrossRefPubMedGoogle Scholar
  23. 23.
    Skoog, SJ, Conlin, MJ 1995Pediatric hernias and hydrocelesUrol Clin North Am22119130PubMedGoogle Scholar
  24. 24.
    Surana, R, Puri, P 1993Is contralateral exploration necessary in infants with unilateral inguinal hernia?J Pediatr Surg2810261027CrossRefPubMedGoogle Scholar
  25. 25.
    Suraseranivongse, S, Chowvanayotin, S, Pirayavaraporn, S,  et al. 2003Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomyReg Anesth Pain Med282428CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Division of Pediatric Surgery, Department of SurgeryUniversity of Hong Kong Medical Centre, Queen Mary HospitalHong KongChina
  2. 2.Department of AnesthesiaUniversity of Hong Kong Medical Center, Queen Mary HospitalHong KongChina

Personalised recommendations