Refinements in selection criteria for pediatric laparoscopic inguinal hernia repair

Purpose: The aim of this study was to evaluate and refine the current criteria used in patient selection for pediatric laparoscopic inguinal hernia repair. Methods: An institutional review board-approved, retrospective review of the medical records of all children undergoing laparoscopic inguinal hernia repair by a single pediatric surgeon in an academic medical center was performed. Due to a high recurrence rate, refinements in patient selection criteria (primarily limiting the operation to 6 year olds and under) were made after the first 75 hernias were repaired. This study compared the early and late experience. Results: Between June 2004 and October 2007, 165 hernias were repaired laparoscopically in 116 children. Group A represents the first 75 hernias repaired, while group B includes the subsequent 90 repairs. Age range was 3 weeks to 14 years for group A and 4 weeks to 6 years of age for group B. Group A had two recurrences (2.6), while group B had none. Both recurrences presented within 1 month of the procedure. Residents participated in suturing 24 hernias in group A, 1 of which developed a recurrence postoperatively, and 13 hernias in group B. Conclusions: Limiting elective pediatric laparoscopic hernia repair to children aged 6 years and under can decrease recurrence rates. While any new technique involves an operator learning curve, the relative simplicity of the procedure and the stable operative times across the series suggests that the reduced recurrence rate is not attributable to operator experience alone.