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June 5, 2026

Laparoscopic Versus Open Repair for Pediatric Inguinal Hernia

Key Points

This review aims to systematically evaluate the benefits and harms of laparoscopic versus open approaches for pediatric inguinal hernia repair.
Conducted systematic searches for RCTs in children under 18 comparing mesh-free laparoscopic versus open repair.
Critical outcomes included recurrence and various complications, assessed through clinical and imaging methods.
No significant difference in recurrence rates was found (OR 0.64, 95% CI 0.26 to 1.61, p=0.35; low-certainty evidence).
No intraoperative injuries reported, limiting effect size assessment.
No differences in postoperative acute pain within 24 hours noted (low-certainty evidence).

Abstract

Abstract Background There is a need for a high-quality systematic review with meta-analyses to evaluate the laparoscopic approach versus the open approach for inguinal hernia repair in children, as available evidence is based on diﬀerent interpretations or calculations of the same RCTs. This abstract is based on a post-peer review version of a Cochrane Review. Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews. Aims To compare the benefits and harms of laparoscopic versus open repair in pediatric inguinal hernia. Methods Through systematic searching we identified RCTs in children (18) comparing mesh-free laparoscopic vs open inguinal hernia repair. Our critical outcome was recurrence, assessed by clinical examination +/- verified by diagnostic imaging. Important outcomes comprised intraoperative complications, complications according to Clavien-Dindo 3a, 3b-4 and 5, postoperative acute pain within 24 hours and chronic pain persisting for more than six months after surgery. Results We included 12 randomized controlled trials analyzing 1247 children undergoing either laparoscopic or open inguinal hernia repair. Pooled analysis showed no clear diﬀerence in recurrence between laparoscopic and open repair (OR 0.64, 95% CI 0.26 to 1.61, p=0.35; 9 studies, 1099 participants; low-certainty evidence). There were no intraoperative injuries reported across studies, preventing estimation of eﬀect size (5 studies, 450 participants; low-certainty evidence). Clavien-Dindo 3a and 5 could not be pooled as there were no events in either group (7 studies, 573 participants; low-certainty evidence). For postoperative acute pain, no diﬀerences were detected at 24 hours (4 studies, 220 participants). Conclusion Laparoscopic and open inguinal hernia repair in children appears to result in comparable recurrence rates. Laparoscopic repair may reduce minor complications (Clavien-Dindo 1-2) and acute postoperative pain. Future high-quality trials with standardized outcome reporting are needed.

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