Our Experience in Comparing Laparoscopic and Open Herniotomy For Pediatric Inguinal Hernia Repair: Revisiting the Debate
Iranian Journal of Pediatric Surgery,
Vol. 9 No. 1 (2023),
11 May 2023
,
Page 10-25
https://doi.org/10.22037/irjps.v9i1.38815
Abstract
Introduction: Traditionally, open groin exploration has been done for congenital inguinal hernia and hydrocele, but recently, laparoscopic herniotomy has gained popularity and has become a successful alternative to open herniotomy. This study compares Laparoscopic herniotomy [LH] and Open herniotomy [OH] regarding operative time, patency of contralateral internal ring, post-op complications, recurrence rates, and parental satisfaction.
Materials and Methods: A multicentric randomized prospective comparative study was done at two tertiary care centers in North India. A total of 180 patients (newborn to 12 years) with congenital inguinal hernia and congenital hydrocele were included based on the inclusion criteria and were randomized using computer-generated numbers to assign to open and laparoscopic herniotomy surgery groups. Various parameters were evaluated during the pre-op, intra-op, and post-op periods.
Results: The study was carried out from Nov 2014 to April 2019. The majority of the patients operated on had a right inguinal hernia in both groups (50% in each group). For bilateral inguinal hernia or hydrocele mean time taken by open technique was 41.16 minutes, and by laparoscopy was 37.75 minutes. In the case of unilateral hernia/hydrocele, it was 20.24 minutes by open technique compared to 24.3 minutes by laparoscopy. But the difference in operative time was statistically not significant.
Conclusion: Based on our observation and results, we conclude that both laparoscopic and open techniques are equally effective and comparable in managing inguinal hernia and hydrocele, with advantages and disadvantages. Claims of one procedure being better than the other and counterclaims of one being more complicated than the other are ill-founded, and the efficacy of each procedure must be viewed with an unbiased approach.
- hernia
- open herniotomy
- laparoscopic herniotomy
- pediatric hernia
- pediatric surgery
How to Cite
References
Holcomb III GW, Miller KA, Chaignaud BE, et al; The parental perspective regarding the contralateral inguinal region in a child with a known unilateral inguinal hernia. Journal of pediatric surgery. 2004 Mar 1;39(3):480-2.
Potts WJ, Riker WL, Lewis JE; The treatment of inguinal hernia in infants and children. Annals of surgery. 1950 Sep;132(3):566.
Parelkar SV, Oak S, Gupta R, et al; Laparoscopic inguinal hernia repair in the pediatric age group—experience with 437 children. Journal of pediatric surgery. 2010 Apr 1;45(4):789-92.
Esposito C, Escolino M, Cortese G, et al; Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surgical endoscopy. 2017 Mar;31:1461-8.
Shalaby R, Ismail M, Samaha A, et al; Laparoscopic inguinal hernia repair; experience with 874 children. Journal of pediatric surgery. 2014 Mar 1;49(3):460-4.
Alzahem A: Laparoscopic versus open inguinal herniotomy in infants and children: a meta-analysis. Pediatric Surgery International. 2011 Jun;27:605-12.
Turial S, Enders J, Krause K,et al; Laparoscopic inguinal herniorrhaphy in babies weighing 5 kg or less. Surgical endoscopy. 2011 Jan;25:72-8.
Nagraj S, Sinha S, Grant H, et al; The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less. Pediatric surgery international. 2006 Jun;22:500-2.
Phelps S, Agrawal M; Morbidity after neonatal inguinal herniotomy. Journal of pediatric surgery. 1997 Mar 1;32(3):445-7.
Lobe TE, Schropp KP; Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side. Journal of laparoendoscopic surgery. 1992 Jun;2(3):135-40.
Clarke S; Pediatric inguinal hernia and hydrocele: an evidence-based review in the era of minimal access surgery. Journal of laparoendoscopic & advanced surgical techniques. 2010 Apr 1;20(3):305-9.
Tsze DS, Hirschfeld G, Dayan PS, et al; Defining no pain, mild, moderate, and severe pain based on the Faces Pain Scale–Revised and Color Analog Scale in children with acute pain. Pediatric emergency care. 2018 Aug;34(8):537.
Chan KL, Hui WC, Tam PK; “Prospective, randomized, single centre, single blind comparison of laparoscopic vs open repair of pediatric inguinal hernia”. Surgical Endoscopy and Other Interventional Techniques19(2005):927-932.
Schier F, Montupet P, Esposito C; Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. Journal of pediatric surgery. 2002 Mar 1;37(3):395-7.
Rathauser F; Historical overview of the bilateral approach to pediatric inguinal hernias. The American journal of surgery. 1985 Nov 1;150(5):527-32.
Erez I, Rathause V, Vacian I, et al; Preoperative ultrasound and intraoperative findings of inguinal hernias in children: a prospective study of 642 children. Journal of pediatric surgery. 2002 Jun 1;37(6):865-8.
Miltenburg DM, Nuchtern JG, Jaksic T, et al; Laparoscopic evaluation of the pediatric inguinal hernia—a meta-analysis. Journal of pediatric surgery. 1998 Jun 1;33(6):874-9.
Sumida W, Watanabe Y, Takasu H, et al; Incidence of contralateral patent processus vaginalis in relation to age at laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia. Surgery today. 2016 Apr;46:466-70.
Zhong H, Wang F; Contralateral metachronous hernia following negative laparoscopic evaluation for contralateral patent processus vaginalis: a meta-analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2014 Feb 1;24(2):111-6.
Chang YT, Lin JY, Lee JY, et al; Comparative mid-term results between inguinal herniotomy and single-port laparoscopic herniorrhaphy for pediatric inguinal hernia. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2012 Dec 1;22(6):526-31.
Muensterer OJ, Woller T, Metzger R, et al; The economics of contralateral laparoscopic inguinal hernia exploration: Cost calculation of herniotomy in infants. Der Chirurg. 2008 Nov;79:1065-71.
Manoharan S, Samarakkody U, Kulkarni M, et al; Evidence-based change of practice in the management of unilateral inguinal hernia. Journal of pediatric surgery. 2005 Jul 1;40(7):1163-6.
Lee Y, Liang J; Experience with 450 cases of micro-laparoscopic herniotomy in infants and children. Pediatric Endosurgery and Innovative Techniques. 2002 Mar 1;6(1):25-8.
Lobe TE, Schropp KP; Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side. Journal of laparoendoscopic surgery. 1992 Jun;2(3):135-40.
Cam C, Celik C, Sancak A, et al; Inguinal herniorrhaphy in childhood may result in tubal damage and future infertility. Archives of gynecology and obstetrics. 2009 Feb;279:175-6.
Chan KL, Hui WC, Tam PK; Prospective randomized single-center, single-blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surgical Endoscopy and Other Interventional Techniques. 2005 Jul;19:927-32.
Lobe TE, Schropp KP; Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side. Journal of laparoendoscopic surgery. 1992 Jun;2(3):135-40.
Bharathi RS, Arora M, Baskaran V; Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS: Journal of the Society of Laparo endoscopic Surgeons. 2008 Jul;12(3):277.
Koivusalo AI, Korpela R, Wirtavuori K, et al; A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics. 2009 Jan; 123(1):332-7.
Ekstein P, Szold A, Sagie B, et al; Laparoscopic surgery may be associated with severe pain and high analgesia requirements in immediate post-operative period. Ann Surg. 2006;243:41–46.
Bharathi RS, Arora M, Baskaran V; Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS: Journal of the Society of Laparo endoscopic Surgeons. 2008 Jul;12(3):277.
Wills VL, Hunt DR; Pain after laparoscopic cholecystectomy. British Journal of Surgery. 2000 Mar;87(3):273-84.
Yang C, Zhang H, Pu J, et al; Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. Journal of pediatric surgery. 2011 Sep 1;46(9):1824-34.
Carneiro PM; Inguinal herniotomy in children. East African medical journal. 1990 May 1;67(5):359-64.
Skoog SJ, Conlin MJ; Pediatric hernias and hydroceles. The urologist's perspective. The Urologic Clinics of North America. 1995 Feb 1;22(1):119-30.
Grosfeld JL, Minnick K, Shedd F,et al; Inguinal hernia in children: factors affecting recurrence in 62 cases. Journal of pediatric surgery. 1991 Mar 1;26(3):283-7.
Hossain T, Zaman S, Hasina K, et a;: A Comparative Study between the Outcome of Laparoscopic Repair and Open Repair of Paediatric Inguinal Hernia. Bangladesh Journal of Endosurgery. 2013 Jul 30;1(2):29-34.
- Abstract Viewed: 76 times
- PDF Downloaded: 96 times