Prospective randomized single-center, single-blind Comparison of laparoscopic vs open repair of pediatric inguinal hernia

Abstract

The repair of indirect inguinal hernia (IH) is one of the most common pediatric surgical procedures, and open surgery (OS) is the standard treatment. The aim of this study was to determine whether the recently developed laparoscopic repair (LR) of IH is superior to OS. Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients at our institution into OS and LR groups. Fourteen patients were excluded from the study for various reasons, leaving study population of 83 patients. After operation, multiple dressings were placed to blind observers to the operation type. Two pain scales, the children and Infants Postoperative Pain were used to assess postoperative pain. Acetaminophen (15 mg/kg/dose every 6 h) was given at a fixed pain score. Analgesic doses were compared. Parents also provided assessments of their children's recovery and wound appearance. The amount of acetaminophen taken by the OS group (n = 42) was 1.05 +/- 1.248 doses per patient, whereas the amount taken by the LR group (n = 41) was 0.54 +/- 0.84 dose per patient (p = 0.032; 95% confidence interval 0.45-0.976). Laparoscopy detected 11 more bilateral hernias (p = 0.006). Although the operative times did not differ significantly for bilateral hernias (39.08 +/- 13.37 min vs 34.0 +/- 11.31 min, p = 0.623), it did differ for unilateral hernias (18.38 +/- 5.71 vs 23.25 +/- 6.26 min, p = 0.001). Five contralateral hernias were detected in the OS group on follow-up, but none were found in the LR group (p = 0.026). The scores given by parents for recovery and wound appearance were higher in the LR group (p = 0.05). As compared with IH patients who undergo open surgery, those who have a laparoscopic repair suffer less pain, and their recovery and wound cosmesis are more satisfactory. With LR, contralateral hernias can be detected and repaired in a single operative procedure. This procedure takes slightly longer for unilateral than for bilateral hernias.