Alexander T Gibbons1, Rachel E Hanke2, Alejandra M Casar Berazaluce2, Sophia Abdulhai1, Ian C Glenn1, Neil L McNinch1, Masao Endo3, Sohail Shah4, Keigo Yada5, Przemyslaw Wolak6, Charles M Leys7, Arturo Aranda8, Go Miyano9, Peter Midulla10, Dariusz Patkowski11, Nathan M Novotny12, Todd A Ponsky13. 1. Akron Children's Hospital, Akron, Ohio, USA. 2. Cincinnati Children's Hospital, Cincinnati, Ohio, USA. 3. Saitama City Hospital, Saitama, Japan. 4. Texas Children's Hospital, Houston, Texas, USA. 5. University of Tokushima, Tokushima, Japan. 6. Jan Kochanowski University, Kielce, Poland. 7. American Family Children's Hospital, Madison, Wisconsin, USA. 8. Dayton Children's Hospital. Dayton, Ohio, USA. 9. Juntendo University School of Medicine, Tokyo, Japan. 10. Mount Sinai Hospital, New York, New York, USA. 11. Medical University of Wroclaw, Wroclaw, Poland. 12. Beaumont Children's Hospital, Royal Oak, Michigan, USA. 13. Akron Children's Hospital, Akron, Ohio, USA; Cincinnati Children's Hospital, Cincinnati, Ohio, USA. Electronic address: tponsky@gmail.com.
Abstract
PURPOSE: Inguinal hernia repairs are among the most common operations performed by pediatric surgeons. Laparoscopic high ligation is a popular technique, but its recurrence rate in adolescents is unknown. We hypothesized that recurrence after laparoscopic high ligation in adolescents would be similar to open repair (1.8%-6.3%). METHODS: We evaluated adolescent patients (12-18 years old at the time of surgery) who underwent laparoscopic high ligation across eleven hospitals. At least six months postoperatively, they were contacted by telephone for follow-up. Variables analyzed included demographics, operative details, recurrence, and other complications. RESULTS: A total of 144 patients were enrolled. One hospital (n=9) had a recurrence rate of 44.4%, compared to 3.0% (4/135) for the other hospitals. By accounting for 50.0% of recurrences, it represented a statistical outlier and was excluded, leaving 135 patients for analysis. The median age was 14 years, and 63.7% were male. Recurrence with the excluded center was 5.6% (8/144). Use of absorbable suture (OR 42.67, CI 4.41-412.90, p<0.01) and braided suture (OR 12.10, CI 1.54-95.25, p=0.02) was weakly associated with recurrence. Recurrence was not significantly different from published results. CONCLUSION: Laparoscopic high ligation of adolescent inguinal hernias has a recurrence rate similar to open repair when performed by experienced surgeons. TYPE OF STUDY: Prognosis study (retrospective study) LEVEL OF EVIDENCE: Level II.
PURPOSE: Inguinal hernia repairs are among the most common operations performed by pediatric surgeons. Laparoscopic high ligation is a popular technique, but its recurrence rate in adolescents is unknown. We hypothesized that recurrence after laparoscopic high ligation in adolescents would be similar to open repair (1.8%-6.3%). METHODS: We evaluated adolescent patients (12-18 years old at the time of surgery) who underwent laparoscopic high ligation across eleven hospitals. At least six months postoperatively, they were contacted by telephone for follow-up. Variables analyzed included demographics, operative details, recurrence, and other complications. RESULTS: A total of 144 patients were enrolled. One hospital (n=9) had a recurrence rate of 44.4%, compared to 3.0% (4/135) for the other hospitals. By accounting for 50.0% of recurrences, it represented a statistical outlier and was excluded, leaving 135 patients for analysis. The median age was 14 years, and 63.7% were male. Recurrence with the excluded center was 5.6% (8/144). Use of absorbable suture (OR 42.67, CI 4.41-412.90, p<0.01) and braided suture (OR 12.10, CI 1.54-95.25, p=0.02) was weakly associated with recurrence. Recurrence was not significantly different from published results. CONCLUSION: Laparoscopic high ligation of adolescent inguinal hernias has a recurrence rate similar to open repair when performed by experienced surgeons. TYPE OF STUDY: Prognosis study (retrospective study) LEVEL OF EVIDENCE: Level II.