Individualized treatment of pediatric inguinal hernia reduces adolescent recurrence rate: an analysis of 3006 cases

Purpose We implemented the individualized treatment (IT) regimen for children with inguinal hernia and the Lichtenstein hernioplasty using an acellular tissue matrix patch (LHAP) for those with high risks. This retrospective study compares the complications of conventional laparoscopic high hernia sac ligation (LHSL) with those of the IT regimen for the management of pediatric inguinal hernia and investigates whether the recurrence rate of inguinal hernias in children treated by IT is lower than that of those treated by LHSL. Methods The subjects of this retrospective study were 3006 children who underwent LHSL or IT for inguinal hernia between February, 2008 and February, 2016 at the Beijing Chao-Yang Hospital (Beijing, China). They comprised 1516 (50.4%) children who underwent LHSL between February, 2008 and December, 2012, and 1490 (49.6%) who underwent IT between January, 2013 and June, 2016. We analyzed the patients' data, including clinical characteristics and postoperative complications. The mean follow-up was 85.31 months for the LHSL group and 43.34 months for the IT group (P < 0.01). Given the difference in the follow-up periods, the log-rank test was used to analyze the recurrence rate. Results The mean age, weight, and height of these children at the time of surgery were 6 years old, 24.17 kg, and 114.48 cm in the LHSL group and 6 years old, 24.57 kg, and 115.18 cm in the IT group, respectively (P = 0.647, P = 0.393, P = 0.505). The mean age, body weight, and height for adolescents at the time of surgery were 14.7 years old, 57.19 kg, and 168.37 cm in the LHSL group and 14.9 years old, 57.96 kg and 169.21 cm in the IT group, respectively (P = 0.099, P = 0.061, P = 0.059). The male/female ratio was 5.1:1 (1268/248) in the LHSL group and 4.9:1 (1241/249) in the IT group (P = 0.795). The side ratio of inguinal hernia (right/left/bilateral) was about 10:7:8 (602/430/484) in the LHSL group and 3.8:2.8:3.4 (567/422/501) in the IT group (P = 0.551). The comorbidities of the male patients included hydrocele (206), cryptorchidism (15), umbilical hernia (12), congenital heart disease (16), and other congenital diseases (25). The comorbidities in the female patients included round ligament cysts (11). There was no significant difference between the groups in postoperative complications including hydrocele (P = 0.687), hematoma (P = 0.061), surgical site infection (P = 0.742), testicular atrophy (not found), and umbilical trocar hernia (P = 0.585). There were two cases of recurrence in the IT group and eight in the LHSL group (P = 0.07). The frequency of postoperative recurrence of adolescent inguinal hernia was 3.16% (7/221) in the LHSL group, 0 (0/223) in the IT group (P = 0.008), and 0 (0/128) in the LHSL subgroup in the IT group (P = 0.045). Conclusion The favorable outcomes of IT, which had a lower recurrence rate than LHSL for adolescent inguinal hernia, demonstrate that this is a reasonable treatment regimen for pediatric inguinal hernia.