Recurrence after laparoscopic high ligation in adolescents: A multicenter international retrospective study of ten hospitals

Purpose: Inguinal hernia repairs are among the most common operations performed by pediatric surgeons. Laparoscopic high ligation is a popular technique, but its reatrrence rate in adolescents is unknown. We hypothesized that recurrence after laparoscopic high ligation in adolescents would be similar to open repair (1.8%-6.3%). Methods: We evaluated adolescent patients (12-18 years old at the time of surgery) who underwent laparoscopic high ligation across eleven hospitals. At least six months postoperatively, they were contacted by telephone for follow-up. Variables analyzed included demographics, operative details, recurrence, and other complications. Results: A total of 144 patients were enrolled. One hospital (n=9) had a recurrence rate of 44.4%, compared to 3.0% (4/135) for the other hospitals. By accounting for 50.0% of recurrences, it represented a statistical outlier and was excluded, leaving 135 patients for analysis. The median age was 14 years, and 63.7% were male. Recurrence with the excluded center was 5.6% (8/144). Use of absorbable suture (OR 42.67, CI 4.41-412.90, p <0.01) and braided suture (OR 12.10, CI 1.54-95.25, p =0.02) was weakly associated with recurrence. Recurrence was not significantly different from published results. Conclusion: Laparoscopic high ligation of adolescent inguinal hernias has a recurrence rate similar to open repair when performed by experienced surgeons. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study evaluated the recurrence rate of laparoscopic high ligation in adolescent patients and found that the rate was similar to open repair after excluding an outlier. The use of absorbable and braided sutures was weakly associated with recurrence.