Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Tolulope A Oyetunji
Start Date
10-5-2023 11:30 AM
End Date
10-5-2023 1:30 PM
Presentation Type
Abstract
Description
Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).
Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.
Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, while laparoscopic repair involves hydro-dissection and percutaneous suture passage for high ligation. Demographics, operative characteristics, and complications were compared.
Results: 1200 patients (598 open, 602 laparoscopic) were included. LIHR was associated with shorter operative duration compared to the open cohort for unilateral (20 vs. 26 minutes, p < 0.01) and bilateral IHR (27 vs. 37.5 minutes, p < 0.01), respectively. Seventy patients (5.8%) required re-operation, either for recurrence or metachronous contralateral inguinal hernia (MCIH); Forty-five patients developed a recurrence (3.75%) (15 open, 30 laparoscopic, p = 0.02), and 25 patients (2%) developed a MCIH (20 open, 5 laparoscopic, p < 0.01). Open IHR was performed in more male patients who underwent unilateral repair (p < 0.01) at a younger age (p = 0.03), as an outpatient procedure (p < 0.01) compared to laparoscopic repair. In multivariate regression analysis, there were no statistically significant variables which affected the risk of recurrent operative intervention.
Conclusions: LIHR is associated with shorter operative duration, despite a higher incidence of prematurity and increased medical complexity. While recurrence was more frequent with laparoscopic repair, more patients who underwent open repair required a second procedure for a MCIH. Surgeons should be adept at both techniques to accommodate patient anatomy and comorbidities to minimize morbidity.
MeSH Keywords
laparoscopy; inguinal hernia; pediatric
Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison of 1200 Patients
Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).
Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.
Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, while laparoscopic repair involves hydro-dissection and percutaneous suture passage for high ligation. Demographics, operative characteristics, and complications were compared.
Results: 1200 patients (598 open, 602 laparoscopic) were included. LIHR was associated with shorter operative duration compared to the open cohort for unilateral (20 vs. 26 minutes, p < 0.01) and bilateral IHR (27 vs. 37.5 minutes, p < 0.01), respectively. Seventy patients (5.8%) required re-operation, either for recurrence or metachronous contralateral inguinal hernia (MCIH); Forty-five patients developed a recurrence (3.75%) (15 open, 30 laparoscopic, p = 0.02), and 25 patients (2%) developed a MCIH (20 open, 5 laparoscopic, p < 0.01). Open IHR was performed in more male patients who underwent unilateral repair (p < 0.01) at a younger age (p = 0.03), as an outpatient procedure (p < 0.01) compared to laparoscopic repair. In multivariate regression analysis, there were no statistically significant variables which affected the risk of recurrent operative intervention.
Conclusions: LIHR is associated with shorter operative duration, despite a higher incidence of prematurity and increased medical complexity. While recurrence was more frequent with laparoscopic repair, more patients who underwent open repair required a second procedure for a MCIH. Surgeons should be adept at both techniques to accommodate patient anatomy and comorbidities to minimize morbidity.
