Laparoscopic inguinal hernia repair in children: true herniotomy is more reliable than herniorrhaphy

BACKGROUND: The optimal laparoscopic technique for pediatric inguinal hernia continues to be discussed with a view to its further refinement. AIM: This study aimed to ascertain the outcomes of two laparoscopic fully intra-corporeal techniques employed in our practice: herniorrhaphy and true herniotomy. METHODS: A retrospective comparative review of patient outcomes was conducted following laparoscopic groin hernia repair: herniorrhaphy — 1st series and true herniotomy — 2nd series. Patient data was analysed using non-parametric statistics with Mann-Whitney test. RESULTS: In total there were 328 patients, aged between 2 months and 17 years, with 402 groin hernia defects including metachronous and rare defects. The herniorrhaphy was performed for indirect hernia defects (n=186) and herniotomy — for indirect (n=206) as well as for direct (n=6) and femoral (n=2) defects. Technically, there were no intraoperative complications in any case in either series. Conversion to open procedure was required in one patient of 1st series (0,5%) with giant hernia because of the impossibility to maintain due pneumoperitoneum. The postoperative recovery was prompt and uneventful with restoration of mobility and oral intake within 3–6 hours in all patients with no difference between the series. Adverse postoperative events were noted in 10 patients after herniorrhaphy — hydrocele (n=6; 3.2%) and hernia recurrence (n=4; 2.2%) whereas after herniotomy there was only one case (n=1; 0.5%) of hydrocele and none of recurrence. The overall rate of these complications was significantly lower in the herniotomy series vs herniorrhaphy (p=0.004). CONCLUSION: Laparoscopic intracorporeal techniques both herniorrhaphy and true herniotomy are safe and effective for pediatric hernia repair. True herniotomy appears to be a more robust technique to minimise incidence of postoperative hydrocele and recurrence.