Abstract
Background
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.
Methods
Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients at our institution into OS and LR groups. Fourteen pateints 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.
Results
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).
Conclusions
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.
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References
W Buttner W Finke (2000) ArticleTitleAnalysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies Paediatr Anaesth 10 303–318 Occurrence Handle10.1046/j.1460-9592.2000.00530.x Occurrence Handle10792748
PM Carneiro (1990) ArticleTitleInguinal herniotomy in children East Afr Med J 67 359–364 Occurrence Handle2390959
KL Chan PKH Tam (2003) ArticleTitleA safe laparoscopic technique for the repair of inguinal hernias in boys J Am Coll Surg 196 987–989 Occurrence Handle10.1016/S1072-7515(03)00121-2 Occurrence Handle12788439
KL Chan PKH Tam (2004) ArticleTitleTechnical refinements in laparoscopic repair of childhood inguinal hernia Surg Endosc 18 957–960 Occurrence Handle10.1007/s00464-003-4220-2 Occurrence Handle15095082
CJ Davis ME Arregui (2003) ArticleTitleLaparoscopic repair for groin hernias Surg Clin North Am 83 1141–1161 Occurrence Handle10.1016/S0039-6109(03)00122-1 Occurrence Handle14533908
PF Ehrlich KD Newman GM Haase TE Lobe ES Wiener GW Holcomb (2002) ArticleTitleLessons learned from a failed multi-institutional randomized controlled study J Pediatr Surg 37 431–436 Occurrence Handle10.1053/jpsu.2002.30853 Occurrence Handle11877662
DP Geisler S Jegathesan MC Parmley JM McGee MG Nolen TA Broughan (2001) ArticleTitleLaparoscopic exploration for the clinically undetected hernia in infancy and childhood Am J Surg 182 693–696 Occurrence Handle10.1016/S0002-9610(01)00797-8 Occurrence Handle11839340
JL Grosfeld K Minnick F Shedd KW West FJ Rescoria DW Vane (1991) ArticleTitleInguinal hernia in children: factors affecting recurrence in 62 cases J Pediatr Surg 26 283–287 Occurrence Handle10.1016/0022-3468(91)90503-L Occurrence Handle2030473
MH Harvey MJ Johnstone DP Fossard (1985) ArticleTitleInguinal herniotomy in children: a five year survey Br J Surg 72 485–487 Occurrence Handle4016518
JM Laberge (2002) ArticleTitleWhat’s new in pediatric surgery? J Am Coll Surg 195 208–218 Occurrence Handle10.1016/S1072-7515(02)01267-X Occurrence Handle12168968
WY Lau (2002) ArticleTitleHistory of treatment of groin hernia World J Surg 26 748–759 Occurrence Handle10.1007/s00268-002-6297-5 Occurrence Handle12053232
MA Levitt D Ferraraccio MC Arbesman GF Brisseau MC Caty PL Glick (2002) ArticleTitleVariability of inguinal hernia surgical technique: a survey of North American pediatric surgeons J Pediatr Surg 37 45–751 Occurrence Handle10.1053/jpsu.2002.32269
F Lyon D Dawson (2003) ArticleTitleOucher or CHEOPS for pain assessment in children Emerg Med J 20 IssueID5 470 Occurrence Handle10.1136/emj.20.5.470 Occurrence Handle12954696
AW Majeed G Troy JP Nicholl et al. (1996) ArticleTitleRandomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy Lancet 347 989–994 Occurrence Handle10.1016/S0140-6736(96)90143-9 Occurrence Handle8606612
McCormack K, Scott NW, Go PM, et al. (2003) Laparocopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785
PJ McGrath G Johnson JT Goodman et al. (1985) ArticleTitleCHEOPS: a behavioral scale for rating postoperative pain in children Pain Res Ther 9 395–402
P Montupet C Esposito (1999) ArticleTitleLaparoscopic treatment of congenital inguinal hernia in children J Pediatr Surg 34 420–423 Occurrence Handle10.1016/S0022-3468(99)90490-6 Occurrence Handle10211645
R Prasad HN Lovvorn SuffixIII GM Wadle TE Lobe (2003) ArticleTitleEarly experience with needleoscopic inguinal hemiorhaphy in children J Pediatr Surg 38 1055–1058 Occurrence Handle10.1016/S0022-3468(03)00191-X Occurrence Handle12861538
F Schier (1998) ArticleTitleLaparoscopic hemiorrhaphy in girls J Pediatr Surg 33 1495–1497 Occurrence Handle10.1016/S0022-3468(98)90483-3 Occurrence Handle9802799
F Schier (2000) ArticleTitleLaparoscopic surgery of inguinal hernias in children – initial experience J Pediatr Surg 35 1331–1338 Occurrence Handle10.1053/jpsu.2000.9326 Occurrence Handle10999691
F Schier P Montupet C Esposito (2002) ArticleTitleLaparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs J Pediatr Surg 37 395–397 Occurrence Handle10.1053/jpsu.2002.30842 Occurrence Handle11877655
JR Shawn CWH Marion M Brindle RL Moss (2003) ArticleTitleSmall evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies J Pediatr Surg 38 1429–1433 Occurrence Handle10.1016/S0022-3468(03)00491-3 Occurrence Handle14577063
SJ Skoog MJ Conlin (1995) ArticleTitlePediatric hernias and hydroceles Urol Clin North Am 22 119–130 Occurrence Handle7855948
R Surana P Puri (1993) ArticleTitleIs contralateral exploration necessary in infants with unilateral inguinal hernia? J Pediatr Surg 28 1026–1027 Occurrence Handle10.1016/0022-3468(93)90509-J Occurrence Handle8229590
S Suraseranivongse S Chowvanayotin S Pirayavaraporn et al. (2003) ArticleTitleEffect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy Reg Anesth Pain Med 28 24–28 Occurrence Handle10.1053/rapm.2003.50010 Occurrence Handle12567339
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Chan, K., Hui, W. & Tam, P. Prospective randomized single-center, single-blind Comparison of laparoscopic vs open repair of pediatric inguinal hernia . Surg Endosc 19, 927–932 (2005). https://doi.org/10.1007/s00464-004-8224-3
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DOI: https://doi.org/10.1007/s00464-004-8224-3