Surgical methods and outcomes of inguinal hernia repair in children, adolescents and young adults in a retrospective cohort study.

Abstract

Laparoscopic repair as an alternative option for pediatric inguinal hernia has increased worldwide. We aimed to analyze the surgical methods of inguinal hernia repair among children, adolescents and young adults, and evaluate the surgical outcomes of reoperation and postoperative complications. This is a hospital-based retrospective cohort study. 3249 inpatients who were ≤ 25 years and underwent inguinal hernia repair between 2015 and 2021 were included. Baseline data, hernia characteristics, surgical approach and technique, outcomes including reoperation and postoperative complications before discharge were identified from electronic medical records. Multivariable Cox regression and logistic regression were used to analyze the association between surgical methods and outcomes. Of all participants, 72.82% were children younger than 9 years, 79.62% were male, 81.19% underwent laparoscopic surgery. Laparoscopic sac high ligation was the mostly used method among infants and children who were younger than 13 years (from 61.11% in 10-12 years old to 96.77% in 0-3 years old), open and laparoscopic tension-free repairs were more common for adolescents and young adults older than 13 years (from 92.38% in 13-15 years old to 100% in 19-21 years old). During a median follow-up of 51.91 months, 24 (0.74%) reoperations were identified, including 3 (0.09%) ipsilateral recurrence, and 21 (0.65%) metachronous contralateral inguinal hernia (MCIH) repair. The rate of complications before discharge was 0.37%. There were no significantly differences in reoperation (aHR = 0.51, 95%CI: 0.12-2.19) and complications (aOR = 0.83, 95%CI: 0.17-4.11) between laparoscopic and open surgery. Age < 3 years (aHR = 6.40, 95%CI: 1.66-24.61), unilateral hernia (aHR = 11.09, 95%CI: 1.46-84.30), and anemia (aHR = 8.58, 95%CI: 1.94-38.05) were independent risk factors for reoperation. Obstruction/gangrene was independent risk factor for complications (aOR = 17.16, 95%CI: 4.07-72.38). Laparoscopic sac high ligation was most commonly performed in children < 13 years, and open and laparoscopic tension-free repairs were more frequently in those > 13 years. Both laparoscopic and open approaches were safe and effective, with low incidence of reoperations and complications.