Optimizing surgical techniques for the repair of inguinal hernias in infants

Background: Laparoscopic inguinal hernia repair (IHR) has become increasingly popular in children, particularly in infants <6 months old, despite limited data on technical variations and outcomes relative to open IHR. This multicenter retrospective study examined how rates of subsequent inguinal hernias in infants were affected by cauterizing the internal ring and using permanent suture during laparoscopic IHR. We also assessed the impact of performing diagnostic laparoscopy during open IHR. Methods: Patients <6 months old who underwent primary IHR between 1/1/2018 and 12/31/2019 were identified at 14 children's hospitals within a regional clinical research consortium. Information was collected regarding patient demographics, operative technique, and incidence of subsequent inguinal hernia (recurrent ipsilateral and metachronous contralateral inguinal hernia). Results: Among 1532 infants identified, 1016 (66.3 %) underwent open IHR and 516 (33.7 %) underwent laparoscopic IHR. Median time from primary IHR to data entry was 6 years. Performing ring cauterization and using permanent suture during laparoscopic IHR was associated with a significantly lower incidence of recurrent ipsilateral hernia (0.5 % versus. 6.2 %, p < 0.01), comparable to the recurrence rate after open IHR (0.5 % versus 1.2 %, p = 0.40). Similarly, diagnostic laparoscopy during open IHR was associated with a significantly lower incidence of metachronous contralateral hernia (1.4 % versus 3.8 %, p = 0.03), comparable to the rate seen after laparoscopic IHR (1.4 % versus 1.2 %, p = 0.79). Conclusion: In infants <6 months old undergoing primary IHR, rates of subsequent inguinal hernias can be significantly reduced by cauterizing the internal ring and using permanent suture during laparoscopic IHR and by performing diagnostic laparoscopy during open IHR.