Laparoscopic versus open inguinal hernia repair

Considerations when counselling parent:

1. Age+ metachronous hernia risk : Chances of a metachronous hernia reduce with increasing age
2. Age + recurrence risk : laparoscopic recurrence rate may be higher in older patients
3. Sex of patient: consider laparoscopic for bilateral inguinal hernia in female patient
4. Cost : Open surgery is more cost effective
5. Surgeon learning curve

Laparoscopic inguinal hernia

Benefits of laparoscopic approach:
1. Detection of metachronous hernia
2. Reduced pain
3. Better cosmesis

Limitations
1. Longer operative time
2. Greater Cost

Complication data available from some large series:

Large series data available from Oyetunji lab, Children’s Mercy Kansas. https://pubmed.ncbi.nlm.nih.gov/33741178/

• 791 patients  
•  Age: median age at operation =1.9 years (IQR 0.37, 5.82).  
• Time: median operative time= unilateral 21 min (IQR 16, 28), bilateral 30.5 min (IQR 23, 41). 
• Complications
  • Intra-op:
    • Conversion to open = 3/ 791 (0.4%)
  • Post-op:
    • Bleeding:  4/791 (0.6%)  
    • Wound infection : 9/791 (1.2%) developed a wound infection 
    • Recurrence: 20/791 (2.5%)
    • Iatrogenic ascent of testis = 10 (1.3%)