OUTCOMES OF INFRA UMBALICAL LAPAROTOMY APPROACH VS CONVENTIONAL INGUINAL APPROACH IN THE MANAGEMENT OF IRREDUCIBLE INGUINAL HERNIAS IN CHILDREN: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Inguinal hernias that turn out to be complicated with irreducibility and obstruction can cause danger to the life of the child and add to morbidity. This study aims to investigate the outcomes of the infra-umbilical transverse laparotomy incision approach compared to the conventional inguinal approach in the management of irreducible inguinal hernias in children, with a focus on postoperative complications, recurrence rates, length of hospital stay, and cosmetic results.

Materials & Methods: This randomized controlled trial was conducted in department of pediatric surgery, children hospital Lahore from Jan 2022 to Jul 2023 after IRB approval. Eighty four patients with irreducible inguinal hernia were selected and enrolled in this study. Patients were divided randomly into two groups; Group-A (operated via conventional inguinal approach) and Group-B (via infra umbilical laparotomy approach), 42 in each group. Post-operative complications, ease of procedure, and outcomes were compared between these two groups. All the Data were entered in SPSS 24. An independent simple t-test was used for comparison of variables.

Results: Forty two patients presenting with irreducible inguinal hernias to the emergency department in each group were compared, With over all 94% being male and 6% female. Mean age of patients was 12.09 ± 11.35 months. Mean duration of symptoms prior to presentation was 29.07 ±6.53 hours. Following surgery through conventional inguinal approach, 9.5 % experienced scrotal swelling, 5.3% experienced recurrence,4.2 % had bowel injury during dissection, 2.50% had injury to vas deferens 1.5% had iatrogenic undescended testis and 2.5% mortality rate. While patients operated via infra umbilical laparotomy approach has only complication of wound infections 3.4% with no other complications encountered as compared to conventional inguinal approach. Post-operative complications were significantly less in infra umbilical laparotomy approach.

Conclusion: The current study concluded that post-operative complications were less with infra umbilical laparotomy approach as compared to conventional inguinal approach. Infra umbilical approach should be adopted in cases of irreducible, obstructed and strangulated inguinal hernia for better outcomes.