Comparison of pain between laparoscopic percutaneous extraperitoneal closure (LPEC) and open procedure for inguinal hernias in children below 5 years of age
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In brief
In brief
This comparative study challenges assumptions about laparoscopic inguinal hernia repair in young children, finding that LPEC technique did not reduce postoperative pain compared to open surgery when measured by FLACC scores. The counterintuitive results were most pronounced in children under 2 years old.
- LPEC did not reduce postoperative pain compared to open inguinal hernia repair in children under 5 years (FLACC scores: 0.44 vs 0.21).
- Pain difference was most pronounced in children under 2 years, where laparoscopic approach showed higher FLACC scores (0.5 vs 0.09).
- Minimally invasive technique does not guarantee less postoperative pain in young pediatric patients who cannot verbalize discomfort.
- FLACC scoring system provides objective pain assessment in preverbal children undergoing inguinal hernia repair.
- Traditional open approach may be preferable for pain control in very young children despite larger incision size.
Written by the GCMD Library team from the article.
Abstract
Purpose
The laparoscopic approach (LA) for repairing inguinal hernias (IH), especially laparoscopic extraperitoneal percutaneous closure (LPEC) has become popular minimally invasive surgical technique. However, invasiveness is difficult to evaluate in children of < 5 years of age, as they cannot adequately express their pain. The current study utilized a pain scoring system compare pain in patients of < 5 years of age who were treated by LA or traditional open approach (OA).
Methods
The records of 74 IH patients of < 5 years of age who underwent surgery in our hospital between January 2022 and July 2023 were reviewed. Revised Face, Legs, Activity, Cry, and Consolability (FLACC) scores were used to quantitatively evaluate the degree of pain.
Results
Forty-seven patients (mean age, 2.85 years) underwent treatment with an OA, and 27 patients (mean age, 2.37 years) underwent treatment with an LA. The FLACC scores in the OA and LA groups were 0.21 and 0.44, respectively. In a subanalysis by age groups, The FLACC scores in the OA and LA groups were 0.09 and 0.5 in patients of < 2 years of age, respectively,
Conclusion
The reduced invasiveness of LA relative to OA did not minimize postoperative pain, especially in patients < 2 years of age.