Comparison of laparoscopic percutaneous extraperitoneal closure (LPEC) and open herniotomy (OH) in pediatric inguinal hernia: a retrospective cohort study on operative time and complications.

BACKGROUND

Laparoscopic surgery is widely used for pediatric inguinal hernia repair, but evidence from resource-limited settings remains scarce. This study compared outcomes of open herniotomy (OH) and laparoscopic percutaneous extraperitoneal closure (LPEC) in a regional Thai hospital.

METHODS

We conducted a retrospective review of children who underwent OH or LPEC between January 2018 and January 2024. A one-to-one propensity score-matched cohort was created based on age and sex. Outcomes included operative time, anesthetic time, and complications. Univariable and multivariable linear regression identified factors influencing operative and anesthetic time.

RESULTS

Among 358 operations, 118 matched pairs (236 patients) were analyzed. Median operative time was longer for unilateral LPEC (30 vs. 25 min, p < 0.001) but shorter for bilateral cases (35 vs. 45 min, p = 0.027). Anesthetic time was longer in unilateral LPEC (70 vs. 55 min, p < 0.001) with no difference for bilateral repairs. Multivariable analysis showed LPEC added 4.3 min (95% CI: 0.8-7.9) to operative time after adjusting for confounders. Complication (OH 15.0% vs. LPEC 13.5%) and recurrence rates (1.2% vs. 1.1%) were similar. Metachronous contralateral inguinal hernia (MCIH) occurred only in OH (13.4%), whereas CPPV was detected in 38.6% of unilateral LPEC cases (NNT = 9).

CONCLUSION

LPEC is safe, prevents MCIH, and should be considered a first-line option when available.