Surgical Endoscopy

, Volume 33, Issue 7, pp 2050–2060 | Cite as

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

  • Christoffer Skov OlesenEmail author
  • Kristoffer Andresen
  • Stina Öberg
  • Jacob Rosenberg
Review Article



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.


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.


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.


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.


Groin hernia Laparoscopic repair Open repair Children 


Compliance with ethical standards


Jacob Rosenberg declares conflict of interest not directly related to the submitted work (Jacob Rosenberg has received personal fees outside the submitted work from Bard and Merck). Christoffer Skov Olesen, Kristoffer Andresen and Stina Öberg declare no conflict of interest or financial ties to disclose.


  1. 1.
    Bisgaard T, Kehlet H, Oehlenschlager J, Rosenberg J (2014) Acceptable nationwide outcome after paediatric inguinal hernia repair. Hernia 18:325–331. CrossRefGoogle Scholar
  2. 2.
    Zani A, Eaton S, Hoellwarth M, Puri P, Tovar J, Fasching G, Bagolan P, Lukac M, Wijnen R, Kuebler J, Cecchetto G, Rintala R, Pierro A (2014) Management of pediatric inguinal hernias in the era of laparoscopy: results of an international survey. Eur J Pediatr Surg 24:9–13. CrossRefGoogle Scholar
  3. 3.
    International Pediatric Endosurgery Group (2010) IPEG guidelines for inguinal hernia and hydrocele. J Laparoendosc Adv Surg Tech 20:10–14. Google Scholar
  4. 4.
    The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. CrossRefGoogle Scholar
  5. 5.
    Skandalakis J, Colborn G, Androulakis J, Skandalakis L, Pemberton L (1993) Embryologic and anatomic basis of inguinal herniorrhaphy. Surg Clin N Am 73:799–836CrossRefGoogle Scholar
  6. 6.
    Raveenthiran V, Agarwal P (2017) Choice of repairing inguinal hernia in children: open versus laparoscopy. Indian J Pediatr 84:555–563. CrossRefGoogle Scholar
  7. 7.
    Ibrahim M, Ladan MA, Abdussalam US, Getso KI, Mohammad MA, Chukwuemeka AL-J, Owolabi FL, Akhparov NN, Aipov RR (2015) Open inguinal herniotomy: analysis of variations. Afr J Paediatr Surg 12:131–135. CrossRefGoogle Scholar
  8. 8.
    Timberlake MD, Sukhu TA, Herbst KW, Rasmussen S, Corbett ST (2015) Laparoscopic percutaneous inguinal hernia repair in children: review of technique and comparison with open surgery. J Pediatr Urol 11:262.e1–262.e6. CrossRefGoogle Scholar
  9. 9.
    Juang D, Fraser JD, Holcomb GW III (2016) The laparoscopic approach for repair of indirect inguinal hernias in infants and children. Transl Pediatr 5:222–226. CrossRefGoogle Scholar
  10. 10.
    Yip KF, Tam PKH, Li MKW (2004) Laparoscopic flip-flap hernioplasty: an innovative technique for pediatric hernia surgery. Surg Endosc 18:1126–1129. CrossRefGoogle Scholar
  11. 11.
    Becmeur F, Philippe P, Lemandat-Schultz A, Moog R, Grandadam S, Lieber A, Toledano D (2004) A continuous series of 96 laparoscopic inguinal hernia repairs in children by a new technique. Surg Endosc 18:1738–1741. CrossRefGoogle Scholar
  12. 12.
    Feng S, Zhao L, Liao Z, Chen X (2015) Open versus laparoscopic inguinal herniotomy in children: a systematic review and meta-analysis focusing on postoperative complications. Surg Laparosc Endosc Percutan Tech 25:275–280. CrossRefGoogle Scholar
  13. 13.
    Esposito C, Escolino M, Turra F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A (2016) Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 25:232–240. CrossRefGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341. CrossRefGoogle Scholar
  15. 15.
    Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15:239–249CrossRefGoogle Scholar
  16. 16.
    Greenhalgh T, Peacock R (2005) Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ 331:1064–1065. CrossRefGoogle Scholar
  17. 17.
    Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia.
  18. 18.
    Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. In: Cochrane Collaboration. Accessed 3 May 2018
  19. 19.
    The Nordic Cochrane Centre, The Cochrane Collaboration (2014) Review Manager (RevMan) [computer program]. Version 5.3Google Scholar
  20. 20.
    Wallace BC, Dahabreh IJ, Trikalinos TA, Lau J, Trow P, Schmid CH (2012) Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw 49:5CrossRefGoogle Scholar
  21. 21.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefGoogle Scholar
  22. 22.
    Burcharth J, Pommergaard H-C, Rosenberg J (2015) Performing and evaluating meta-analyses. Surgery 157:189–193. CrossRefGoogle Scholar
  23. 23.
    Chan KL, Hui WC, Tam PKH (2005) Prospective randomized single-center, single-blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surg Endosc 19:927–932. CrossRefGoogle Scholar
  24. 24.
    Koivusalo AI, Korpela R, Wirtavuori K, Piiparinen S, Rintala RJ, Pakarinen MP (2009) A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics 123:332–337. CrossRefGoogle Scholar
  25. 25.
    Saha N, Biswas I, Rahman MA, Islam MK (2013) Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia. Mymensingh Med J 22:232–236Google Scholar
  26. 26.
    Celebi S, Uysal AI, Inal FY, Yildiz A (2014) A single-blinded, randomized comparison of laparoscopic versus open bilateral hernia repair in boys. J Laparoendosc Adv Surg Tech A 24:117–121. CrossRefGoogle Scholar
  27. 27.
    Niu X, Song X, Su A, Zhao S (2017) Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac. Medicine (Baltimore) 96:e6563. CrossRefGoogle Scholar
  28. 28.
    Shalaby R, Ibrahem R, Shahin M, Yehya A, Abdalrazek M, Alsayaad I, Shouker MA (2012) Laparoscopic hernia repair versus open herniotomy in children: a controlled randomized study. Minim Invasive Surg 2012:484135. Google Scholar
  29. 29.
    Gause CD, Casamassima MGS, Yang J, Hsiung G, Rhee D, Salazar JH, Papandria D, Pryor HI, Stewart D, Lukish J, Colombani P, Chandler NM, Johnson E, Abdullah F (2017) Laparoscopic versus open inguinal hernia repair in children ≤ 3: a randomized controlled trial. Pediatr Surg Int 33:367–376. CrossRefGoogle Scholar
  30. 30.
    Oral A, Karaca L, Ahiskalioglu A, Yildiz A, Yigiter M, Celikkaya ME, Chyndolotov T, Salman AB (2018) Effects of laparascopic hernia repair by PIRS (percutan internal ring suturing) technique on testicular artery blood supply. J Investig Surg. Google Scholar
  31. 31.
    Bharathi RS, Arora M, Baskaran V (2008) Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS 12:277–281Google Scholar
  32. 32.
    Cui Z, Xie B, Zhang R (2018) Laparoscopic inguinal hernia repair and Lichtenstein tension-free hernia repair for children in 13–18 years old: a prospective, randomized, single-blind controlled trial. Biomed Res 29:460–464. Google Scholar
  33. 33.
    Shalaby RY, Fawy M, Soliman SM, Dorgham A (2006) A new simplified technique for needlescopic inguinal herniorrhaphy in children. J Pediatr Surg 41:863–867. CrossRefGoogle Scholar
  34. 34.
    Harrison MR, Lee H, Albanese CT, Farmer DL (2005) Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: a novel technique. J Pediatr Surg 40:1177–1180. CrossRefGoogle Scholar
  35. 35.
    Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznanski W (2006) Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 16:513–517. CrossRefGoogle Scholar
  36. 36.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403. CrossRefGoogle Scholar
  37. 37.
    Sonderman KA, Wolf LL, Armstrong LB, Taylor K, Jiang W, Weil BR, Koehlmoos TP, Ricca RL, Weldon CB, Haider AH, Rice-Townsend SE (2018) Testicular atrophy following inguinal hernia repair in children. Pediatr Surg Int 34:553–560. CrossRefGoogle Scholar
  38. 38.
    Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W (2015) How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg 2:24. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Center for Perioperative OptimizationHerlev Hospital, University of CopenhagenHerlevDenmark

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