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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 12-14

Laparoscopic versus open inguinal hernia repair: A patient's perspective


1 Department of Pediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
2 Lilavati Hospital and Research Centre, Joy Hospital and Fortis Group of Hospitals, Mumbai, Maharashtra, India

Date of Web Publication10-Jul-2017

Correspondence Address:
Rajesh Nathani
Lilavati Hospital and Research Centre, Joy Hospital and Fortis Group of Hospitals, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJL.SJL_1_17

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  Abstract 

Background: The optimal method of hernia repair in children is still debatable in spite of a large number of clinical trials comparing open and laparoscopic repairs.
Aim: The aim of this study is to compare laparoscopic versus open herniotomy with regard to a patient's perspective in terms of immediate postoperative recovery and comfort and long-term satisfaction with the procedure.
Settings and Designs: This is a retrospective study from January 2014 to 2016 conducted at a tertiary care center. Materials and Methods: A total of eighty consecutive patients (forty open and forty laparoscopic) who underwent inguinal hernia repair were included in this study. Postoperatively on follow-up, which ranged from 6 to 20 months, the patient and/or parent were interviewed by a questionnaire. This included documentation of postoperative pain which was assessed by visual analog scales and face, legs, activity, cry, consolability scoring system according to the age of the child, time of discharge from hospital, postoperative complications and time taken to return to normal activities, recurrence of hernia or hernia on the opposite side, cosmesis, and problems associated with scars.
Results and Conclusions: Patients in the laparoscopic group fared better than the open group in terms of postoperative pain, return to routine activities, and cosmesis. However, there was one recurrence on the same side in this group. No recurrences on the operated side were observed in the open group; however, three contralateral hernias were operated in this group.

Keywords: Comparison, laparoscopic hernia repair, open hernia repair, patient's perspective


How to cite this article:
Hathiramani V, Raj V, Chigicherla S, Nathani R. Laparoscopic versus open inguinal hernia repair: A patient's perspective. Saudi J Laparosc 2017;2:12-4

How to cite this URL:
Hathiramani V, Raj V, Chigicherla S, Nathani R. Laparoscopic versus open inguinal hernia repair: A patient's perspective. Saudi J Laparosc [serial online] 2017 [cited 2017 Nov 17];2:12-4. Available from: http://www.saudijl.org/text.asp?2017/2/1/12/209995


  Introduction Top


Inguinal hernia is one of the most common pediatric surgical conditions, with an incidence of 0.8%–4.4% in the general population. The optimal method of hernia repair is still debatable; whether open or laparoscopically. The traditionally performed open hernia repair has very high success and low complication rates.[1],[2] However, there are some issues such as the debate about managing the contralateral groin in children who present with a unilateral inguinal hernia,[3] and in the case of recurrence, repeated surgery of the cord entails the risk of damaging the spermatic vessels or vas deferens.[4],[5] The laparoscopic repair deals with both these issues and claims better cosmesis, lesser pain, and earlier return to activities as compared to the open procedure. This article aims to study a different perspective that it is a patient's perspective, on both these methods of hernia repair.


  Materials and Methods Top


A total of eighty consecutive patients (forty open and forty laparoscopic) who underwent inguinal hernia repair from January 2012 to January 2014 were included in this study. Patients with associated undescended testes, complicated hernias, previous abdominal surgeries and those unwilling to participate in the study were excluded from the study.

Postoperatively on follow-up, which ranged from 6 to 20 months, the patient and/or parent were interviewed by a questionnaire. This included documentation of postoperative pain which was assessed by visual analog scales and face, legs, activity, cry, consolability scale scoring system according to the age of the child, time of discharge from hospital, postoperative complications and time taken to return to normal activities, recurrence of hernia or hernia on the opposite side, cosmesis, and problems associated with scars.

The data were then analyzed and the results were formulated.


  Results Top


Postoperative pain

In the open group, postoperative pain was a significant problem in nine patients and persisted for 1–2 days after the surgery and was controlled by oral pain killers. In the laparoscopic group, pain was a problem in five patients that persisted for a day after surgery and settled with oral pain killers.

Time of discharge

Twenty-three patients from the open group and 27 from the laparoscopic group were discharged on the same day. Seven from the open group and three from the laparoscopic group were discharged the next day for reasons such as pain and parent apprehension. The rest stayed as their insurance plan required hospitalization for 24 h.

Hematoma

One patient from the open group developed a hematoma postoperatively which was managed conservatively. None of the patients noticed any obvious difference in testicular size postoperatively.

Return to normal activity

The duration of return to normal activities and playing was about 14–21 (mean of 18.3) days in the open group and 7–9 (mean of 8) days in the laparoscopic group.

Recurrence and contralateral hernia

One patient from the open group had a hernia on the opposite side after 11 months of the first surgery, and one patient from the laparoscopic group had a recurrence on the same side which was then operated by an open repair as per the patient's choice.

Cosmesis

Patients in the laparoscopic group were happier with the scars as they nearly felt them be invisible. The open group was satisfied with the scar as it was concealed by clothing but did feel the presence of a scar.


  Discussion Top


In children, the standard surgical treatment of inguinal hernia is limited to division and ligation of the hernial sac at the internal inguinal ring without narrowing the ring.[6] The internal ring normally is reached by dissecting the hernial sac from the cord structures. Open herniotomy is an excellent method of repair in the pediatric population. However, it has the potential risk of injury of the spermatic vessels or vas deferens, hematoma formation (as seen in one of our patients), wound infection, iatrogenic ascent of the testis, testicular atrophy, and recurrence of hernia. It also carries the potential risk of tubal or ovarian damage which may cause infertility.[7],[8]

The quest for limiting pain and access damage together with the pursuit of better cosmesis has led to the development of laparoscopy and other video-assisted surgical procedures. These have been made possible in children by advances in technology and instrumentation. Laparoscopic surgery is a technically demanding procedure, as compared to the open method, and it is now becoming popular among pediatric surgeons.

During the last 10 years, minimally invasive surgical techniques have been adopted whole-heartedly in pediatric surgical practice. Laparoscopic approach is rapidly gaining popularity with more and more studies validating its feasibility, safety, and efficacy.[6],[9] So far, in children, only a few randomized studies have assessed medical and economic justification of laparoscopic procedures in relation to open ones.

Advantages of laparoscopic inguinal hernia repair include excellent visual exposure and magnification, ability to evaluate the contralateral side, minimal dissection and avoidance of access trauma to the vas deferens and testicular vessels, iatrogenic ascent of the testis, and decreased operative time, especially in recurrent and obese cases.[6],[10]

Considering that 5.6%–16% children will develop a contralateral inguinal hernia,[11],[12],[13] the laparoscopic approach deals with the problem of contralateral hernia at the same time, thus obviating the need for a second operation and anesthesia and reducing both the economic impact and risks to the patient.


  Conclusions Top


Patients in the laparoscopic group fared better than the open group in terms of postoperative pain, return to routine activities, and cosmesis. However, there was one recurrence on the same side in this group.

No recurrences on the operated side were observed in the open group; however, three contralateral hernias were operated in this group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chatterjee SK. Inguinal hernia. Pediatr Surg Int 1993;8:453-4.  Back to cited text no. 1
    
2.
Potts WJ, Riker WL, Lewis JE. The treatment of inguinal hernia in infants and children. Ann Surg 1950;132:566-76.  Back to cited text no. 2
    
3.
Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML. Laparoscopic evaluation of the pediatric inguinal hernia – A meta-analysis. J Pediatr Surg 1998;33:874-9.  Back to cited text no. 3
[PUBMED]    
4.
Janik JS, Shandling B. The vulnerability of the vas deferens (II): The case against routine bilateral inguinal exploration. J Pediatr Surg 1982;17:585-8.  Back to cited text no. 4
    
5.
Wantz GE. Testicular atrophy as a risk inguinal hernioplasty. Surg Gynecol Obstet 1982;154:570-1.  Back to cited text no. 5
    
6.
Lee Y, Liang J. Experience with 450 cases of microlaparoscopic herniotomy in infants and children. Paediatr Endosurgery Innov Tech 2002;1:25-8.  Back to cited text no. 6
    
7.
Shalaby R, Ismail M, Dorgham A, Hefny K, Alsaied G, Gabr K, et al. Laparoscopic hernia repair in infancy and childhood: Evaluation of 2 different techniques. J Pediatr Surg 2010;45:2210-6.  Back to cited text no. 7
    
8.
Cam C, Celik C, Sancak A, Iskender C, Karateke A. Inguinal herniorrhaphy in childhood may result in tubal damage and future infertility. Arch Gynecol Obstet 2009;279:175-6.  Back to cited text no. 8
    
9.
Ozgediz D, Roayaie K, Lee H, Nobuhara KK, Farmer DL, Bratton B, et al. Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: Report of a new technique and early results. Surg Endosc 2007;21:1327-31.  Back to cited text no. 9
    
10.
Saranga Bharathi R, Arora M, Baskaran V. Pediatric inguinal hernia: Laparoscopic versus open surgery. JSLS 2008;12:277-81.  Back to cited text no. 10
    
11.
Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg 2007;16:50-7.  Back to cited text no. 11
    
12.
Montupet P, Esposito C. Laparoscopic treatment of congenital inguinal hernia in children. J Pediatr Surg 1999;34:420-3.  Back to cited text no. 12
    
13.
Marulaiah M, Atkinson J, Kukkady A, Brown S, Samarakkody U. Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia? J Pediatr Surg 2006;41:2004-7.  Back to cited text no. 13
    




 

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
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