A comparison of pain between laparoscopic and open procedures for inguinal hernia in young children

Abstract

Abstract Purpose The laparoscopic approach (LA) for inguinal hernia (IH) repair has become widely spread as a minimally invasive surgical technique, but few studies have compared its degree of pain with that of the open approach (OA). However, invasiveness is difficult to evaluate in children under five years old, as they cannot adequately express their pain. Therefore, the present study compared the degree of pain with the LA with that of the OA in children under five years old using a pain scoring system at our institute. Material and methods The records of 74 IH patients under 5 years old who underwent surgery between January 2022 and July 2023 were reviewed and compared in terms of the age, operative method, operative diagnosis, operation time, postoperative symptoms, and complications. The revised Face, Legs, Activity, Cry, and Consolability (FLACC) scores were used to evaluate the degree of pain quantitatively. Results Forty-seven patients with a mean age of 2.85 years old underwent the OA, while 27 patients with a mean age of 2.37 years old underwent the LA. During the LA, the contralateral patent processus vaginalis was identified in eight patients. The average operation time was 46.2 min for the OA and 37.8 min for LA. Both groups experienced similar rates of a postoperative fever, pain, and vomiting. The mean FLACC scores were 0.21 and 0.44 in the OA and LA groups, respectively. In a subanalysis by age groups, the average operation durations in patients < 2 years old were 48.9 and 33.9 min in the OA and LA groups, respectively, whereas those in patient 3–5 years old were 44.0 and 39.6 min in the OA and LA groups, respectively. The FLACC scores in patients < 2 years old were 0.09 and 0.5 in the OA and LA groups, respectively, and those in patients 3–5 years old were 0.3 and 0.18 in the OA and LA groups, respectively. Conclusion The LA can be performed to avoid contralateral recurrences, and the operation time is reduced in patients under two years old. However, the reduced invasiveness of the LA compared with the OA did not minimize postoperative pain, especially in patients under two years old.