title: Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial.
abstract: OBJECTIVE
  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 ≤3 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 finding 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.
  
  
  CONCLUSIONS
  Children ≤3 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.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Gause
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maria G Sacco
authors.initials: MGS
authors.lastname: Casamassima
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Hsiung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rhee
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA.
authors.forename: Dominic
authors.initials: D
authors.lastname: Papandria
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Howard I
authors.initials: HI
authors.lastname: Pryor
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lukish
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Colombani
authors.affiliation: Department of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Emilie
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. FAbdullah@luriechildrens.org.|Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 63, Chicago, IL, 60611, USA. FAbdullah@luriechildrens.org.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Inguinal hernia repair; Laparoscopy; MIS; Outcomes; Pediatric; SEAL