Abstract
Background
Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children.
Methods
Retrospective study including all cases of inguinal hernia repair in children at two large centers. Demographic data and outcome parameters including procedure time and intra as well as postoperative complications were evaluated. To compare open vs. closed hernia sack preparation, cases with secondary open preparation were excluded and propensity score matching was performed. Regression analysis was used to determine factors affecting operative time and recurrence rate.
Results
In total 2476 cases of inguinal hernia repair were identified. After exclusion of direct hernias as well as revision cases, 2257 cases were analyzed. Overall mean operative time was 25.8 min. Intraoperative complications occurred in 0.1% and. postoperative complications occurred in 3.0% of all cases, the most frequent postoperative complication being recurrence (1.7%). Closed preparation technique resulted in significantly faster procedure time and lower recurrence rates in premature neonates and older children compared to the open hernia sac preparation technique. Operative technique, prematurity, gender and training of the surgeon are highly associated with operative time, whereas operative technique is the main factor affecting recurrence rate.
Conclusions
It appears that closed hernia sack preparation is superior to open regarding speed and recurrence. This was true for premature neonates, neonates and older children. All other outcome parameters including intra- and postoperative complications were similar. Thus, we recommend to use the closed preparation technique whenever possible.
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References
Fu YW, Pan ML, Hsu YJ, Chin TW (2018) A nationwide survey of incidence rates and risk factors of inguinal hernia in preterm children. Pediatr Surg Int 34:91–95. https://doi.org/10.1007/S00383-017-4222-0
Pan ML, Chang WP, Lee HC et al (2013) A longitudinal cohort study of incidence rates of inguinal hernia repair in 0- to 6-year-old children. J Pediatr Surg 48:2327–2331. https://doi.org/10.1016/J.JPEDSURG.2013.06.004
Öberg S, Andresen K, Rosenberg J (2017) Etiology of Inguinal hernias: a comprehensive review. Front Surg. https://doi.org/10.3389/FSURG.2017.00052/FULL
Oj M, E G, (2019) Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review. Int J Surg (London, England) 68:11–19. https://doi.org/10.1016/J.IJSU.2019.06.001
Ein SH, Njere I, Ein A (2006) Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 41:980–986. https://doi.org/10.1016/J.JPEDSURG.2006.01.020
Nah SA, Giacomello L, Eaton S et al (2011) Surgical repair of incarcerated inguinal hernia in children: Laparoscopic or open? Eur J Pediatr Surg 21:8–11. https://doi.org/10.1055/S-0030-1262793
Sachs M, Damm M, Encke A (1997) Historical evolution of inguinal hernia repair. World J Surg 21:218–223. https://doi.org/10.1007/S002689900220
Ravi K, Hamer DB (2003) Surgical treatment of inguinal herniae in children. Hernia 7:137–140. https://doi.org/10.1007/S10029-003-0126-0
Olesen CS, Andresen K, Öberg S, Rosenberg J (2019) Laparoscopic versus open repair of groin hernias in children: a systematic review and meta-analysis. Surg Endosc 33(7):2050–2060. https://doi.org/10.1007/S00464-019-06740-Y
Dreuning K, Maat S, Twisk J et al (2019) Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis. Surg Endosc 33:3177–3191. https://doi.org/10.1007/S00464-019-06960-2
Türk E, Erdal Memetoglu M, Edirne Y et al (2014) Inguinal herniotomy with the Mitchell-Banks’ technique is safe in older children. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2013.09.065
Nazem M, Heydari Dastgerdi MM, Sirousfard M (2015) Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia. J Res Med Sci 20:1172. https://doi.org/10.4103/1735-1995.172985
Grosfeld JL, Minnick K, Shedd F et al (1991) Inguinal hernia in children: Factors affecting recurrence in 62 cases. J Pediatr Surg 26:283–287. https://doi.org/10.1016/0022-3468(91)90503-L
Baird R, Gholoum S, Laberge JM, Puligandla P (2011) Prematurity, not age at operation or incarceration, impacts complication rates of inguinal hernia repair. J Pediatr Surg 46:908–911. https://doi.org/10.1016/J.JPEDSURG.2011.02.059
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V.M., K.W., J.T., K.R. and J.E. collected data, J.E. and M.B. performed the analysis. V.M. and M.B. wrote the first draft. All authors reviewed the manuscript
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Michler, V., Elrod, J., Wingtes, K. et al. Should the processus vaginalis sac be opened or closed in pediatric herniotomy? A two-center cohort study. Pediatr Surg Int 38, 1165–1169 (2022). https://doi.org/10.1007/s00383-022-05145-8
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DOI: https://doi.org/10.1007/s00383-022-05145-8