Laparoscopic vs Open Repair of Congenital Inguinal Hernia

Abstract

Background: One of the most frequent surgical diseases seen in pediatric treatment is congenital inguinal hernia. Although open herniotomy has long been the gold standard, laparoscopic repair has become more common since it is less intrusive and allows the contralateral internal ring to be seen. Nonetheless, there is ongoing discussion on which procedure is better in terms of operating time, complications, and recurrence, especially in India's rural tertiary care settings.

Objective: To evaluate the surgical results of open versus laparoscopic congenital inguinal hernia repair in terms of hospital stay, comorbidities, recurrence rates, postoperative pain, and operative time.

Methods: Over the course of eighteen months, this prospective comparative study was carried out at the Department of General Surgery, BMIMS, Pawapuri, Nalanda. Eighty-two pediatric patients with congenital inguinal hernias were randomly assigned to either Group A (open herniotomy, n = 41) or Group B (laparoscopic repair, n = 41). Operative time, contralateral patency, hospital stay, postoperative pain scores (FLACC/VAS), and complications were among the parameters that were documented and examined.

Results: For unilateral repair, the Open group's mean operating time ( min) was considerably less than the Laparoscopic group's ( min) (). However, laparoscopy was quicker for bilateral hernias. In 100% of laparoscopic instances, a contralateral patent processus vaginalis (CPPV) could be found, averting potentially metachronous hernias in 7 patients (17%). The laparoscopic group had considerably decreased postoperative pain scores at six hours (). At the six-month follow-up, there was no discernible difference in the recurrence rates between the two groups (Open: 2.4% vs. Laparoscopic: 2.4%).

Conclusion: In summary, laparoscopic repair offers a secure and efficient substitute for open herniotomy. It gives substantial benefits in terms of decreased postoperative discomfort, superior cosmesis, and the identification of silent contralateral abnormalities, even though it takes a little longer to operate on unilateral instances. Patient selection is crucial to maximizing expenses and results in a setting with limited resources.