title: Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia.
abstract: Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. This prospective comparative study was conducted with initial experience in the department of pediatric surgery, Dhaka Shishu (children) hospital during the period of July 2007 to August 2008. We enrolled 62 children undergoing surgery for inguinal hernia, of which 30 underwent laparoscopic procedure (bilateral in 21, unilateral 9) and 32 open procedures (bilateral in 5, unilateral in 27). Mean±SD patient age was 5.92±2.11 months in laparoscopic group and 6.63±2.64 months in open group (p=0.264), 3 months to 5 years in both groups. Patients were studied under variables of operative time, duration of postoperative hospital stay & post operative complications. During laparoscopy a contralateral patent processus vaginalis of ≥2cm was noted and repaired peroperatively in 18 out of 27 children (66%), who were initially diagnosed as unilateral hernia. For unilateral repair mean±SD operative time was significantly longer in Group A (62.63±52.75) minutes compares to the Group B (29.37±9.40), p<0.001. On the contrary, for bilateral repair Mean±SD operative time was comparable between the two groups (64.65±49.70) minutes for laparoscopy & (35.65±11.53 minutes) for open herniotomy & P=0.01, that was not remarkably significant. The mean±SD post operative length of hospital stay (in hours) 36.00±32.7 hours in Group A compared to 29.97±11.82 hours in Group B which was not statically significant (p=0.342). The mean±SD follow up was 24.5±10.5 months in laparoscopic group (Group A) & 22.5±10.5 months in open group (Group B), p=0.251. Regarding post operative complication, in this study, contra lateral metachronous inguinal hernia (CMIH) manifested in none of the patient out of 27 (total unilateral repaired number) patients in laparoscopic group but contrary to this in open group 2 patients out of 27 had developed CMIH & p value was <0.05, which is statistically significant. There were 2 cases of scrotal hydrocele out of 30, observed in Group A whereas 1 case out of 32 in Group B, p=0.49, which was statistically insignificant. The scrotal hydrocele was lasted only for 2 days & resolved spontaneously. About recurrence after operation, our study noted that, 1 case (3.3%) out of 30 in laparoscopic group and 2 cases (6%) out of 32 in open surgery group had developed recurrent inguinal hernia in about one year follow up where p value was 0.459, & it was statistically insignificant. In this study, none of the patient had developed post operative testicular atrophy (due to any vas or vascular injury) or testicular ascend. So, overall this study result implies that, Laparoscopic herniotomy might be a safe and effective option as open herniotomy for the treatment of inguinal hernia in children but which one would be superior or best option it requires a large series of randomized trial.
authors.affiliation: Department of Peadiatric Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh.
authors.forename: N
authors.initials: N
authors.lastname: Saha
authors.forename: I
authors.initials: I
authors.lastname: Biswas
authors.forename: M A
authors.initials: MA
authors.lastname: Rahman
authors.forename: M K
authors.initials: MK
authors.lastname: Islam
mesh_terms: D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome