A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children

Infographic · Jan 2026 · 1 min read

In brief

This nationwide study of 53,287 pediatric inguinal hernia repairs found laparoscopic approach had 3.7 times higher same-side recurrence rates compared to open repair, though overall second operation rates were similar due to fewer contralateral hernias in the laparoscopic group.

Laparoscopic inguinal hernia repair has 3.7x higher odds of same-side recurrence compared to open repair in children (1.5% vs 0.4%).
Overall second hernia operation rates are similar between approaches when accounting for metachronous contralateral hernias.
Laparoscopic approach now represents 15.6% of pediatric inguinal hernia repairs, reflecting significant adoption over the past decade.
Reduced metachronous hernia rate with laparoscopic repair offsets its higher recurrence risk in overall reoperation rates.
Large national cohort (53,287 operations) with minimum 1-year follow-up provides robust comparative effectiveness data.

Written by the GCMD Library team from the infographic.

The infographic uses a teal and white color scheme with illustrated medical personnel performing surgery. Data is organized in sections with bullet points and percentages. Key statistics are highlighted in yellow boxes at top and bottom, with comparative outcomes displayed in the middle section using color-coded text (red for laparoscopic, green for open).

Michela Carter, Steven T Papastefan, Yao Tian, Stephen J Hartman, Meredith S Elman, Sara G Ungerleider, Aaron P Garrison, Tolulope A Oyetunji, Matthew P Landman, Mehul V Raval, Seth D Goldstein, Timothy B Lautz

Background: Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.

Methods: This retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates.

Results: We identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p = 0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p < 0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS.

Conclusion: Laparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia.

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