Laparoscopic versus open repair for inguinal hernia in children: a retrospective cohort study
We compared the outcomes of laparoscopic surgery (LS) with those of open surgery (OS) for unilateral and bilateral pediatric inguinal hernia.
Using a nationwide claim-based database in Japan, we analyzed data from children younger than 15 years old, who underwent inguinal hernia repair between January 2005 and December 2017. Patient characteristics, incidence of reoperation, postoperative complications, length of hospital stay, and duration of anesthesia were compared between LS and OS for unilateral and bilateral hernia.
Among 5554 patients, 2057 underwent LS (unilateral 1095, bilateral 962) and 3497 underwent OS (unilateral 3177, bilateral 320). The incidence of recurrence was not significantly different between OS and LS (unilateral: OS 0.2% vs. LS 0.3%, p = 0.44, bilateral: OS 0.6% vs. LS 0.6%, p = 1.00). The incidence of metachronous hernias was significantly higher in the OS group than in the LS group (4.8% vs. 1.0%, p < 0.001). The surgical site infection rate was significantly lower after OS than after LS for unilateral surgeries (0.9% vs. 2.2%, p = 0.002). There was no difference between OS and LS in the length of hospital stay.
Both OS and LS had a low incidence of recurrence in children; however, the incidence of metachronous hernias was lower for LS, which may influence operative technique decisions.
KeywordsLaparoscopic hernia repair Pediatric inguinal hernia Contralateral metachronous inguinal hernia Pediatric surgery
We thank Dr. Masato Takeuchi for advice about revising the manuscript.
Compliance with ethical standards
Conflict of interest
K.K. received research funding from Olympus Corporation. M.N. and K.I. have no conflicts of interest to declare.
- 3.Bronsther B, Abrams MW, Elboim C. Inguinal hernias in children—a study of 1000 cases and a review of the literature. J Am Med Womens Assoc. 1972;1972(27):522–5.Google Scholar
- 12.Amano H, Tanaka Y, Kawashima H, Deie K, Fujiogi M, Suzuki K, et al. Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases. Surg Endosc. 2017;31:4988–95.CrossRefGoogle Scholar
- 22.Medical Information System Development Center. https://www2.medis.or.jp/stdcd/byomei/index.html. Accessed 22 Feb 2019 (in Japanese).
- 24.Saranga Bharathi R, Arora M, Baskaran V. Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS. 2008;12:277–81.Google Scholar
- 31.Endo M. Surgical repair of pediatric indirect inguinal hernia: great waves of change from open to laparoscopic approach. J Surg Transpl Sci. 2016. https://www.jscimedcentral.com/Surgery/surgery-4-1034.pdf.
- 33.Chinnaswamy P, Malladi V, Jani KV, Parthasarthi R, Shetty RA, Kavalakat AJ, et al. Laparoscopic inguinal hernia repair in children. JSLS. 2005;9:393–8.Google Scholar
- 35.Obata S, Ieiri S, Jimbo T, Souzaki R, Hashizume M, Taguchi T. Feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia by inexperienced pediatric surgeons: single-incision versus multi-incision randomized trial for 2 years. J Laparoendosc Adv Surg Tech A. 2016;26:218–21.CrossRefGoogle Scholar