Our Summary

This research paper discusses a study comparing two types of hernia repair surgeries in boys - the traditional open hernia repair (OH) and the laparoscopic hernia repair using the extraperitoneal method (LHE).

Inguinal hernia is a common condition in boys where part of the intestine or fat pushes through a weak spot in the abdominal wall, causing a bulge near the groin. This is often treated with surgery. The traditional method, open hernia repair, can sometimes lead to complications involving the testicles. The newer method, LHE, is a less invasive surgery where small instruments are inserted through tiny incisions to repair the hernia, reducing the risk of injury to the spermatic cord structures.

The study involved analyzing data from multiple other studies, including 6 randomized controlled trials and 20 non-randomized studies, involving a total of 17,555 boys. The main outcomes they looked at were complications involving the testicles, recurrence of hernia on the same side, and the occurrence of hernia on the opposite side after surgery.

The study found that the incidence of certain testicular complications (ascending testis) and occurrence of hernia on the opposite side after surgery (MCIH) were significantly lower in the LHE method compared to the OH method. However, the incidence of other complications like hydrocele (fluid-filled sack in the scrotum), testicular atrophy (shrinkage of testes), and recurrence of hernia on the same side did not differ between the two methods.

The study concludes that the LHE method could be a better choice for hernia repair in boys as it leads to fewer or equivalent testicular complications without increasing the recurrence of hernia on the same side. Also, the occurrence of hernia on the opposite side after surgery is lower with the LHE method.

FAQs

  1. What is the main difference between open hernia repair surgery and laparoscopic hernia repair in boys?
  2. What were the primary and secondary outcomes considered in the meta-analysis of studies comparing open hernia repair and laparoscopic hernia repair?
  3. According to the meta-analysis, how does laparoscopic hernia repair compare to open hernia repair in terms of testicular complications and hernia recurrence?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric hernia repair is that laparoscopic hernia repair using the extraperitoneal method (LHE) may lead to fewer testicular complications and a lower incidence of surgical metachronous contralateral inguinal hernia (MCIH) compared to open hernia repair surgery (OH). This less invasive approach could be a feasible choice for pediatric inguinal hernia repair in boys.

Suitable For

Pediatric patients with inguinal hernias are typically recommended for pediatric hernia repair surgery. In particular, boys with inguinal hernias may benefit from laparoscopic hernia repair using the extraperitoneal method, as it has been shown to result in fewer testicular complications and a lower incidence of metachronous contralateral inguinal hernia compared to traditional open hernia repair surgery. This approach may be a feasible and less invasive option for pediatric patients with inguinal hernias.

Timeline

Before pediatric hernia repair:

  • Patient may experience symptoms such as a visible bulge in the groin area, pain or discomfort, and difficulty with activities such as physical exercise
  • Patient may undergo physical examination and imaging tests to confirm the diagnosis of inguinal hernia
  • Surgery may be recommended as the treatment option for pediatric inguinal hernia repair

After pediatric hernia repair:

  • Patient may experience some pain and discomfort at the surgical site, which can be managed with pain medication
  • Patient will be advised to avoid strenuous activities and heavy lifting for a certain period of time to allow for proper healing
  • Follow-up appointments with the surgeon may be scheduled to monitor the healing process and check for any complications
  • Overall, laparoscopic hernia repair by using the extraperitoneal method (LHE) has been shown to have fewer testicular complications and lower incidence of surgical metachronous contralateral inguinal hernia compared to open hernia repair surgery (OH) in pediatric patients

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pediatric hernia repair surgery?
  2. How does laparoscopic hernia repair differ from traditional open hernia repair surgery?
  3. What is the success rate of laparoscopic hernia repair in pediatric patients?
  4. How long is the recovery time after laparoscopic hernia repair surgery compared to open hernia repair surgery?
  5. Are there any long-term implications or considerations for my child after undergoing hernia repair surgery?
  6. What is the likelihood of the hernia recurring after laparoscopic hernia repair surgery?
  7. How experienced is the surgical team in performing laparoscopic hernia repair in pediatric patients?
  8. Are there any specific post-operative instructions or restrictions my child should follow after hernia repair surgery?
  9. Will my child need any follow-up appointments or monitoring after hernia repair surgery?
  10. Are there any alternative treatment options for pediatric hernia repair that we should consider?

Reference

Authors: Cheng PL, Duh YC, Chen JJ, Huang FH. Journal: J Pediatr Surg. 2023 Jul;58(7):1322-1331. doi: 10.1016/j.jpedsurg.2023.01.054. Epub 2023 Feb 14. PMID: 36898876