Laparoscopic Inguinal Hernia Repair in Children: To Cut or Not to Cut is the Question?

Context: Laparoscopic repair of pediatric inguinal hernia is gaining popularity, however there is no consensus about the technique of operation.

Aims: The aim of the study was to compare the results and complications of two techniques of laparoscopic pediatric hernia repair.

Settings And Design: This retrospective study was conducted at the Department of Pediatric Surgery in All India Institute of Medical Sciences (AIIMS), Jodhpur.

Subjects And Methods: All children who underwent laparoscopic inguinal hernia repair at AIIMS, Jodhpur, during the period of September 2016-March 2019 were retrospectively studied. Parameters studied included age, gender, side of hernia, technique used, operating time, complications, and hospital stay. Patients were divided into two groups depending on whether the hernial sac was divided or not divided before taking a purse-string suture.

Statistical Analysis Used: Student's -test and Fischer exact test were used to analyze data.

Results: A total of 114 patients were included in the study. The median age was 36.4 months. Hernial sac was divided before suturing in 53 patients, while sac was left intact in 61 patients. The mean follow-up was 11.4 months (range: 4-16). Age, gender, side of hernia, complications, and hospital stay were comparable in both groups. There was a significant difference between the mean operating duration in patients who underwent division of hernia sac compared to patients in whom the sac was not divided before putting purse-string suture (92.5 min [45-150] vs. 65.7 [30-90], respectively, = 0.0101). Hernia recurrence (3.8% in Group A vs. 1.6% in Group B) was comparable in the two groups.

Conclusions: Laparoscopic pediatric hernia repair done with or without dividing the peritoneal sac gives comparable results, however operative duration is less if sac is not divided.