Effect of a Pediatric Surgeon's Primarily Performed Technique on Inguinal Hernia Recurrence Rates: A Multicenter Retrospective Cohort Study
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Kathleen Heller, Brielle V Ochoa, Stephanie F Brierley, Benjamin E Padilla; Pediatric Inguinal Hernia Collaborative Group
Purpose: To investigate the effect of surgeons' preferred repair technique for pediatric inguinal hernia repair (IHR) -laparoscopic versus open-on hernia recurrence rates.
Methods: We conducted a multicenter retrospective cohort study of patients aged <18 years old who underwent IHR at 21 children's hospitals from 2017 to 2019 with 3 year follow up. Surgeons preferring open hernia repair performed ≥70 % of hernia repairs open (Open surgeons). Surgeons preferring laparoscopic hernia repair performed ≥70 % of hernia repairs laparoscopically (Laparoscopic surgeons). Descriptive statistics and multivariable regression were utilized.
Results: Among 207 surgeons, 125 (60.4 %) were Open surgeons, and of those 54 (43.2 %) performed at least 1 laparoscopic IHR. The inguinal hernia recurrence rates for Open surgeons were 0.9 % for open IHR and 3.6 % for laparoscopic IHR, p < 0.001. There were 58 (28.0 %) Laparoscopic surgeons and of those 44 (75.9 %) performed at least 1 open IHR. The inguinal hernia recurrence rates for Laparoscopic surgeons were 1.7 % for laparoscopic IHR and 1.7 % for open IHR, p = 1.000. For open IHR, no significant difference in recurrence rates was observed between Open and Laparoscopic surgeons (0.9 % versus 1.7 %, p = 0.230). For laparoscopic inguinal hernia repairs, Open surgeons had higher recurrence rates than Laparoscopic surgeons with odds ratio of (3.6 % versus 1.7 %, p = 0.019).
Conclusions: Open surgeons have higher inguinal hernia recurrence rates when performing laparoscopic IHR. No difference in hernia recurrence rates following open and laparoscopic repair was noted for Laparoscopic surgeons. Pediatric surgeons dividing cases between open and laparoscopic IHR should take caution to maintain adequate proficiency in both.
Intended audience: Healthcare professionals and clinicians.
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