Comparative Analysis of Surgical Outcomes Between Open Herniotomy and Laparoscopic Hernia Repair Among Pediatric Patients with Inguinal Hernias: A Five-Year Retrospective Review at Tanzania's National Hospital.

Abstract

Background: Inguinal hernias (IH) are common congenital anomalies in children, requiring surgical repair to prevent complications. The primary methods for repairing pediatric IH are laparoscopic hernia repair (LHR) and open herniotomy (OH). However, there is limited evidence comparing postoperative outcomes between these approaches in Low- and Middle-Income Countries (LMICs).

Objective: To compare postoperative outcomes between OH and LHR among pediatric patients treated at Muhimbili National Hospital (MNH) in Tanzania.

Methodology: This 5-year retrospective comparative cohort study included 156 pediatric patients under 14 years who underwent OH or LHR at MNH from January 2019 to December 2023. Participants were selected using a hybrid random-consecutive sampling technique. LHR and OH patients were recruited at approximately a 1-to-4 ratio. Data was collected from patient records and via phone interviews. Inferential statistical tests were used to compare the outcomes of the two surgical methods.

Results: Participants had a median age of 19.5 months (IQR 10-36) at presentation, with the majority being male (142, 91%). The median age was slightly higher in the LHR group [21.5 (IQR 12-46.5)] compared to 19 months (IQR 9-36) in the OH group. In the subgroup analysis of bilateral hernias (n=22), measures such as the duration of surgery, postoperative length of stay, total hospitalization time, parents` satisfaction, and cosmetic rating favored LHR (p<.05). Satisfaction and cosmesis were also better with LHR for unilateral hernias (n=134) (p<.05). However, the overall recurrence rate was higher with unilateral LHR at 22.7% (5/17) compared to 4.5% (5/107) with OH, p<.05.

Conclusion: While LHR demonstrated shorter operative time, faster recovery, and favourable cosmetic outcomes, the potential for hernia recurrence warrants careful consideration when selecting the surgical approach. Given the inherent methodological limitations, these findings should be interpreted with caution. Nevertheless, the findings provide valuable preliminary evidence that can inform future larger-scale, well-powered studies aimed at evaluating the long-term outcomes of LHR in LMIC settings.