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OBJECTIVE: To compare needle assisted laparoscopic repair (NALR) of inguinal hernia in children with open hernia repair (OHR). METHODS: This randomized controlled trial was conducted at the Paediatric Surgery Unit of Khyber Teaching Hospital, Peshawar, Pakistan from Feburary 2017 to September 2018. Children aged upto 16 years and diagnosed with reducible inguinal hernia were randomized into two-groups; NALR and OHR. Obstructed inguinal hernia and cases which presented with recurrence were excluded from this study. Demographic and clinical data was collected and analysed using SPSS 20. RESULTS: One hundred and fifteen patient were included in the study with NALR (n=50) and OHR group (n=65). NALR group included unilateral (n=35), bilateral hernia (n=5), PPV (n=10). OHR group included unilateral (n=55), bilateral (n=10). The mean age for NALR was 2.96±2.5 years and OHR was 4.17±3.62 years. Mean weight for NALR group was 11±6kg and OHR was 7.6±3.7kg. Operating time for unilateral NALR was 12±2.4 minutes and OHR was 24±3.8 minutes while bilateral NALR was 18.3±3.1 minutes and OHR was 32±6.3 minutes. Hospital stay for NALR group was 40±6.8 hours and OHR was 30±7.7 hours. Analgesia doses for unilateral NALR (4.5±1.2) were less than OHR (6.96±1.8) (p=0.02) and same is the case for bilateral repair (p=0.03). OHR had a high rate of postoperative complications; surgical site edema (14%), wound infection (4%) and recurrence (2.8%). CONCLUSION: NALR is a safe and reliable substitute to OHR in terms of less operating time, minimum hospital stay, less doses of analgesia required and low rate of postoperative complications.

Background: Laparoscopic repair of inguinal hernia has been commonly practiced nowadays, however an extensive debate exist regarding the different techniques and the numbers of port used for its repair. Objective: To share our institutional experience and to compare the outcome of two different laparoscopic techniques of inguinal hernia repair in children. Study design, settings and duration: A prospective randomized controlled trial was conducted at pediatric surgery unit, Khyber Teaching Hospital, Peshawar from July 2015 to January 2017. Subjects and Methods: The children aged below 16 years with a diagnosis of reducible inguinal hernia (IH) were randomly assigned into 2 groups of repair of inguinal hernia, single port laparoscopic needle assisted repair (LNAR) and three port technique of purse string around deep inguinal ring (PSDIR). Demographic and clinical data was collected and analyzed using SPSS 20. Results: A total of 205 laparoscopic repair of inguinal hernia done on 153 patients by the same group of surgeon in same unit. 83 patients underwent single port LNAR with 5 patients having bilateral inguinal hernia and 22 contralateral patent processus vaginalis (CPPV). Seventy patients underwent three port technique of PSDIR having 7 cases with bilateral IH and 18 CPPV. Age ranges from 0 to 16 years with a mean age for single port LNAR 3.6±3.21 years and three ports PSDIR 4.69±3.08 years. Mean weight for single port LNAR 10.5±5.24 kg and PSDIR 12.33±7.47 kg. Mean operating time for unilateral LNAR 10±2.91 min and PSDIR 25.68±3.55 min while bilateral LNAR 16±3.88 min and PSDIR 40±5.59 min. Length of hospital stay (LOHS) for LNAR 30±4.50 hours and PSDIR 38.57±6.15 hours. Analgesia doses for Unilateral LNAR 4.56±1.15 and PSDIR 7.51±1.57 while analgesia for Bilateral LNAR 7.0±1.26 and PSDIR 10.6±1.84. PSDIR has high postoperative complications of recurrence, hydrocele and poor parents satisfaction score. Conclusion: Our results support single port LNAR of inguinal hernia using spinal needle as safe, reliable and effective technique with a high parents satisfaction as compared to three port technique. [ABSTRACT FROM AUTHOR]