Laparoscopic Herniorrhaphy in the Pediatric Age Group: What About the Learning Curve?

Purpose: To evaluate the learning curve of pediatric laparoscopic herniorrhaphy (LH), the authors report a retrospective analysis comparing results obtained with this technique and the traditional herniotomy to determine how many procedures are necessary to obtain the results described in the literature.

Patients And Methods: From May 2008 to February 2012, a total of 140 patients (110 boys and 30 girls) with uncomplicated inguinal hernia (IH) consecutively underwent surgery. Patients were divided in two groups: The "Open" group of 83 patients (M:F 64:19) with a mean age of 33.2 months who were operated on with traditional herniotomy and the "Lap" group of 57 patients (M:F 46:11) with a mean age of 34.5 months who were operated on with LH. Operative time and complications of the techniques were analyzed statistically.

Results: In the Open group, the mean operative time for monolateral repair was 35.4 ± 17.7 minutes compared with the Lap group time of 29.9 ± 15.9 minutes; for bilateral repair, the mean operative time for the Open group was 56.2 ± 19.3 minutes compared with the Lap group time of 41.5 ± 10.4 minutes. The analysis shows a shorter operative time for the laparoscopic repair for both monolateral (P=0.73) and bilateral (P=0.0001) hernia. Recurrences occurred in one (0.9%) patient in the Open group and in two (2.7%) patients in the Lap group (P=0.577).

Conclusions: This experience shows that LH is a reliable technique. Retrospective analysis revealed a shorter mean operative time for the laparoscopic intervention both for monolateral and bilateral IH repair. Recurrences in the Lap group occurred in the first 10 patients treated, and the mean operative time was reached in 20 monolateral LHs and after 15 bilateral herniorrhaphies. From this analysis, the learning curve for the LH needs a minimum of 20 procedures.