A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children

Infographic · Jan 2026 · 1 min read

In brief

Nationwide retrospective study of 53,287 pediatric inguinal hernia repairs found laparoscopic approach had 3.7x higher same-side recurrence versus open repair (1.5% vs 0.4%), though overall second operation rates were similar due to fewer contralateral procedures after laparoscopy.

Written by the GCMD Library team from the infographic.

A four-panel comparison layout with medical illustrations showing different surgical techniques. Each panel contains a cross-sectional anatomical diagram in muted colors (beige, pink, blue) depicting the abdominal wall and omphalocele sac, with surgical materials or closures illustrated. The panels are arranged in a 2x2 grid with consistent styling and annotation markers.

Michela Carter, Steven T Papastefan, Yao Tian, Stephen J Hartman, Meredith S Elman, Sara G Ungerleider, Aaron P Garrison, Tolulope A Oyetunji, Matthew P Landman, Mehul V Raval, Seth D Goldstein, Timothy B Lautz

Background: Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.

Methods: This retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates.

Results: We identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p = 0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p < 0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS.

Conclusion: Laparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia.

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