Pediatric inguinal hernia: open versus laparoscopic approaches to surgical management.

PURPOSE OF REVIEW: Inguinal hernia repair remains one of the most common pediatric surgical procedures. Advances in minimally invasive techniques have made laparoscopic herniorrhaphy a safe alternative to open surgery. This review summarizes clinical outcomes in open and laparoscopic pediatric inguinal hernia repair, discusses technical considerations including anesthetic choice, and reviews patient and surgical factors relevant to surgical approach and timing.

RECENT FINDINGS: Clinical outcomes appear similar in open and laparoscopic pediatric hernia repairs. Open surgery can be performed under regional or general anesthesia and permits direct visualization of the spermatic cord (in men) and high ligation of the hernia sac. The laparoscopic approach requires general anesthesia but permits same-setting visualization of the contralateral inguinal ring and repair of any contralateral hernia. Both techniques effectively manage recurrent hernias. Premature infants undergoing herniorrhaphy after neonatal ICU (NICU) discharge had fewer adverse events and shorter hospital stays than those undergoing surgery while in the NICU.

SUMMARY: Both laparoscopic and open pediatric inguinal hernia repairs are generally well tolerated and effective. Surgeons should be skilled in both approaches and knowledgeable about patient characteristics, anesthetic considerations, and anatomic factors that may favor one approach over another.