Introduction: Techniques for inguinal hernia repair (IHR) in children are continuously being improved. Open repair is increasingly giving way to laparoscopy, with two possible approaches for laparoscopy: extra-peritoneally (Percutaneous Internal Ring Suturing, PIRS) or intra-peritoneally (conventional laparoscopy with purse-string suture). The aim of this trial is to compare outcomes, e.g. recurrence and anesthesia times, of PIRS with intra-corporeal laparoscopy using a purse-string suture (LIHR).
Methods: Subjects were prospectively included in the ‘Pediatric Inguinal Hernia Repair with Laparoscopy’ (PIHRL)-trial, to undergo surgery with PIRS or LIHR. Follow-up was conducted one year after surgery. Data concerning post-operative complications and anesthesia times were collected. Parents were asked to complete two questionnaires (POSAS and TAPQoL/TACQoL) to assess cosmetic results and quality of life.
Results: 177 subjects were included (PIRS n=126, LIHR n=51). There was a baseline difference in age between the groups from the different centers. Total anesthesia time was significantly shorter with PIRS (62.1+24.6min vs. 84.7+21.7min, p=0.001). One readmittance within 30 days occured in the LIHR group due to hemorrhage. This resolved spontaneously without the need for intervention. There was a significant difference in recurrence rate (PIRS n=2, LIHR n=4, p=0.038). One patient in the PIRS group suffered from testicular atrophy (p=0.523) and five re-interventions were necessary after PIRS due to wound complications (p=0.984).
Discussion: PIRS is safe and effective for pediatric IHR, with shorter anesthesia times and a lower recurrence rate compared to LIHR at one year follow-up. Longer follow-up and a larger sample size are necessary to confirm these results.
Keywords: Pediatric Inguinal Hernia Repair; Surgical Techniques; PIRS (Percutaneous Internal Ring Suture); Laparoscopy; Recurrence; Surgical Times; Cosmetic; Quality of Life
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