Laparoscopic versus open repair of groin hernias in children: a systematic review and meta-analysis

Background Regarding groin hernia repair in children, guidelines do not favor open or laparoscopic repair. Even so, most surgeons prefer an open technique. The aim of this systematic review was to compare short- and long-term outcomes after laparoscopic and open groin hernia repair in children. Methods Systematic searches were conducted in three databases, and all randomized controlled trials comparing laparoscopic and open groin hernia repair in children under 18 years were included. Outcomes were postoperative complications, intraoperative complications, operative time, length of hospital stay, time to recovery, and wound appearance. The outcomes were compared between open and laparoscopic repairs in meta-analyses. Results We included ten studies with 1270 patients involving 1392 hernias. We found no differences in recurrence rate, testicular atrophy, hydrocele, hematoma, seroma, infection, pain, length of hospital stay, or time to full recovery. Laparoscopic repair was superior regarding wound appearance. Laparoscopic repair had shorter operative time than open repair for bilateral groin hernias. For unilateral groin hernias, extraperitoneal laparoscopic repair was faster than open repair, but open repair was faster than intraperitoneal laparoscopic repair. Conclusion Our results indicate similar outcome after laparoscopic and open techniques for groin hernia repair in children. The surgeon’s preference as well as the wishes of the patient and parents should therefore determine the surgical approach.