Long-Term, Patient-Reported Outcomes of Pediatric Laparoscopic and Open Inguinal Hernia Repair

Abstract

INTRODUCTION: Long-term outcomes studies of pediatric inguinal hernia repair have been limited and primarily conducted via chart review. We assessed long-term outcomes, including recurrence, through a questionnaire, hypothesizing that laparoscopic repair would not have higher recurrence rate compared with open. METHODS: Families of patients <18 years old undergoing inguinal hernia repair from 2011 to 2018 were administered a questionnaire in 2021 assessing outcomes including recurrence, long-term pain, and cosmetic satisfaction. Chart review was also conducted. Student’s t-tests or Wilcoxon rank sum tests as well as chi-square tests were performed. Time-dependent analysis of laparoscopic vs open recurrence was performed using Kaplan-Meier analysis and log-rank test. RESULTS: Of 506 children, 325 (64%) underwent laparoscopic repair and 181 (36%) open. There was no difference in median (interquartile range) age (20 (4–68) vs 21 (4–66) months, p = 0.69), mean weight (14 ± 12 vs 17 ± 16 kg, p = 0.06), or preoperative incarceration (10% vs 7%, p = 0.22) by approach. The questionnaire was completed by 57% (n = 288) of families for a median follow-up time of 70 (46–93) months. There was no difference in demographics or operative approach between respondents and nonrespondents (all p > 0.05). The recurrence rate among respondents was 3.5% (n = 10) and occurred at a median of 7 (4–14) months after index repair. There was no difference in recurrence after laparoscopic vs open repair (Figure; p = 0.86).FigureCONCLUSION: Patient-reported outcomes were excellent after pediatric inguinal hernia repair in our study with up to 10 years of follow-up. The recurrence rate is equivalently low regardless of laparoscopic or open approach, but it is likely underestimated when assessed by chart review alone.