Considerations when counselling parent:
- Age+ metachronous hernia risk : Chances of a metachronous hernia reduce with increasing age
- Age + recurrence risk : laparoscopic recurrence rate may be higher in older patients
- Sex of patient: consider laparoscopic for bilateral inguinal hernia in female patient
- Cost : Open surgery is more cost effective
- 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%)
- Intra-op: