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Web End = Pediatr Surg Int (2017) 33:367376 DOI 10.1007/s00383-016-4029-4
http://crossmark.crossref.org/dialog/?doi=10.1007/s00383-016-4029-4&domain=pdf
Web End = ORIGINAL ARTICLE
Laparoscopic versus open inguinal hernia repair in children 3: a randomized controlled trial
Colin D. Gause1 Maria G. Sacco Casamassima1 Jingyan Yang2
Grace Hsiung1 Daniel Rhee1 Jose H. Salazar1 Dominic Papandria3
Howard I. Pryor II1 Dylan Stewart1 Jeffrey Lukish1 Paul Colombani1,4
Nicole M. Chandler4 Emilie Johnson5 Fizan Abdullah1,6
Accepted: 30 November 2016 / Published online: 26 December 2016 Springer-Verlag Berlin Heidelberg 2016
AbstractPurpose Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years. Methods A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children B3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores.
Results Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5)
and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent nding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years. Conclusion Children B3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.
Keywords Pediatric Inguinal hernia repair
Laparoscopy MIS SEAL Outcomes
Introduction
Open inguinal hernia repair (OH) remains the standard approach to pediatric inguinal hernias since its initial description over 50 years ago [1]. Advantages include a low rate of recurrence, vas deferens injury and testicular atrophy (\1%) [24]. Pediatric laparoscopic inguinal hernia repair (LH) has now become routinely employed in several pediatric centers. Advantages of LH as reported by retrospective studies include better cosmesis, shorter length of stay (LOS), faster recovery, and greater...