SUBCUTANEOUS ENDOSCOPE ASSISTED LIGATION VERSUS CONVENTIONAL HERNIOTOMY IN PEDIATRIC INGUINAL HERNIA: A PROSPECTIVE COMPARATIVE STUDY

Abstract

Background

The usual treatment for pediatric inguinal hernia is conventional herniotomy. Recently, a new alternative technique (subcutaneous Endoscope-Assisted Ligation, SEAL) has become available, which may achieve the same surgical results while offering better cosmetic outcomes.

Objective

To compare SEAL with conventional herniotomy in terms of early recurrence, operating time, wound infection and cosmesis in children who have inguinal hernia.

Methodology

The study was conducted at the Department of Pediatric and Neonatal Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, a prospective non random comparative study. The 220 children, aged 1-14 years, who had clinical diagnosis of inguinal hernia, were allocated to two groups: SEAL group (n=110) and the conventional herniotomy group (n=110). Patients were followed up for 1 month following surgery. Operative time, wound infection, early recurrence and cosmetic outcome were documented and statistically analyzed with SPSS 25.

Results

There was no significant difference in mean operative time between the SEAL (40.9 ± 9.3 minutes) and conventional herniotomy (42.4 ± 7.8 minutes) groups (p=0.184). Wound infection was reported in 0.9% and 1.8% of patients, respectively (p=0.561) and early recurrence occurred in 3.6% and 1.8% of patients (p=0.684). Compared to conventional herniotomy, excellent cosmetic result was obtained in 56.4% of children who had undergone SEAL (p=0.031).

Conclusion

The early recurrence and wound infection rates were low and both SEAL and conventional herniotomy were safe and effective procedures. Despite similar operative time, cosmetic results were significantly superior with SEAL and may be a preferred minimally invasive option, if available and appropriate expertise and equipment.