The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: RCT

Infographic · Sep 2025 · 1 min read

In brief

Randomized trial of 50 pediatric patients (12 months-8 years) comparing LMA versus ETT for laparoscopic inguinal hernia repair found no clinically significant differences in oxygenation or ventilation, with LMA showing lower peak airway pressures. Results support LMA as a safe alternative to ETT in appropriate pediatric laparoscopic cases.

LMA is as safe and effective as ETT for pediatric laparoscopic inguinal hernia repair in children aged 12 months to 8 years.
No clinically significant difference in oxygenation or end-tidal CO2 between LMA and ETT groups during laparoscopic procedures.
Patients with ETT had higher peak airway pressures compared to LMA at all measured timepoints.
Laryngospasm did not occur in either group; desaturation events were rare and equal (one per group).
LMA may be considered for short pediatric laparoscopic procedures in appropriately selected patients.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows Heller myotomy, the middle shows esophageal dilatation, and the right shows POEM procedure. Success rates are prominently displayed with percentage values.

Emily L. Weisberg, Benjamin J. Pieters , Meredith S. Elman , Cory J. Nonnemacher, Janelle Noel-MacDonnell , Tolulope A. Oyetunji

Background

A laryngeal mask airway (LMA) is routinely used for many types of pediatric surgical procedures and as a rescue airway device. Laparoscopic procedures in pediatric surgery are common and are becoming increasingly widespread. In laparoscopic surgery, the traditional airway approach is the use of endotracheal intubation, while the use of LMA in laparoscopic surgery is not well studied.

Aims

To evaluate the effectiveness of general anesthesia with LMA versus traditional endotracheal tube (ETT) for pediatric patients aged 12 months to 8 years old undergoing laparoscopic inguinal hernia repair.

Methods

In a single institution prospective randomized trial, pediatric patients undergoing laparoscopic inguinal hernia repair were recruited from April 2023 to May 2024. Patients were randomized to general anesthesia with either an LMA or ETT. The primary endpoint was oxygen saturation in percent saturation (SpO2) measured at three standardized timepoints. Secondary endpoints were end tidal carbon dioxide (EtCO2) levels and peak airway pressure (PAP) measurements at the same three standardized timepoints as well as the occurrence of any episodes of laryngospasm or desaturation documented in each group.

Results

Fifty patients underwent laparoscopic inguinal hernia surgery with general anesthesia, twenty-five patients with LMA and twenty-five with ETT. There was no clinically significant difference in oxygenation between study groups. Additionally, there was no statistically significant difference between study arms in EtCO2 levels. Patients with ETT had higher peak airway pressures compared to patients with LMA at all three time points. There was one incident of desaturation in each study arm and no episodes of laryngospasm.

Conclusions

The use of LMA in short laparoscopic surgery is a safe and effective alternative to ETT in appropriate pediatric patients.

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