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Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial

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Abstract

Purpose

Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years.

Methods

A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children ≤3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores.

Results

Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5) and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent finding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years.

Conclusion

Children ≤3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.

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Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Colin D. Gause, Maria G. Sacco Casamassima, Grace Hsiung, Daniel Rhee, Jose H. Salazar, Howard I. Pryor II, Dylan Stewart, Jeffrey Lukish, Paul Colombani & Fizan Abdullah

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Jingyan Yang

  3. Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, USA

    Dominic Papandria

  4. Department of Pediatric Surgery, All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA

    Paul Colombani & Nicole M. Chandler

  5. Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Chicago, IL, USA

    Emilie Johnson

  6. Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Box 63, Chicago, IL, 60611, USA

    Fizan Abdullah

Authors
  1. Colin D. Gause
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  2. Maria G. Sacco Casamassima
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  3. Jingyan Yang
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  14. Fizan Abdullah
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Corresponding author

Correspondence to Fizan Abdullah.

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Gause, C.D., Casamassima, M.G.S., Yang, J. et al. Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial. Pediatr Surg Int 33, 367–376 (2017). https://doi.org/10.1007/s00383-016-4029-4

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