Surgical Repair of Pediatric Indirect Inguinal Hernia: Great Waves of Change from Open to Laparoscopic Approach

This paper reviewed the current procedures for surgical repair of indirect inguinal hernias, highlighting the move from traditional open herniorrhaphy to laparoscopic repair, focusing on the appeal and success of laparoscopic approaches compared to open techniques, and surveyed which method is likely to survive as the gold standard in the future. Integrated comparisons did not favor the laparoscopic approach over open repair, because the wide varieties of laparoscopic approaches were associated with varying results. A recent questionnaire administered to 187 attendees of European Pediatric Surgeons’ Association – British Association of Pediatric Surgeons (EUPSA-BAPS) meeting from 46 countries revealed that most pediatric surgeons still favor open techniques and a laparoscopic approach has yet to be accepted. Analysis of individualized techniques and outcomes in various morbidities, however, revealed the superiority of laparoscopic techniques over open techniques with regard to greater operative ease, fewer complications, and lower recurrence rates, especially in incarcerated/sliding hernias and recurrent hernias. Although laparoscopic hernia repair has not been established long enough to fully consider the risks posed by late complications, growing experience, wider adoption, a decreased prevalence of complications and increasing advantages favor the emergence of the laparoscopic approach as the gold standard in the future.