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What are the factors influencing the surgical approach in hiatal hernia ?
Senda Houidi, Fatma Thamri, Asma Guitouni, Abir Jouini, Yosra Kerkeni, Riadh Jouini
children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia
Introduction
Hiatal hernia repair in pediatric patients presents a clinical challenge with considerations for both laparoscopic and open surgical approaches. Factors influencing the choice between these techniques remain underexplored.We aim to evaluate the key factors that influence the decision between laparoscopic or open surgical repair of hiatal hernias in children.
Materials and methods
A retrospective analysis was conducted on patients undergoing hiatal hernia repair over a 10-year period. Patients were categorized into two groups based on the surgical approach: Group 1 (n=17), which underwent laparoscopic repair, and Group 2 (n=6), which underwent open repair. Data collected included patient demographics, hernia size and type, preoperative symptoms, surgical approach, intraoperative findings, postoperative outcomes, and follow-up assessments.
Results
In this study, a total of 23 pediatric patients were enrolled, with 17 patients (74%) undergoing laparoscopic surgery and 6 patients (26%) undergoing open surgery for hiatal hernia repair. There were no significant differences in gender, body mass index, or age between groups. However, all patients with associated comorbidities, particularly those with neurological impairments, were exclusively managed via the open surgical approach (p<0.001). During intraoperative assessment, patients undergoing laparoscopic surgery had significantly smaller hernia sizes compared to those undergoing open surgery (2.9±1.2 cm vs 4.6±0.8 cm; p=0.042). Furthermore, the type of hernia component differed significantly between groups, with Type IV hernias being more prevalent in the open surgery group (5 out of 6 patients) compared to the laparoscopic surgery group (1 patient) (p=0.012).
Conclusion
These findings underscore the clinical decision-making process in choosing between laparoscopic and open surgical approaches for pediatric hiatal hernia repair, highlighting the influence of hernia size and type on the choice of surgical technique.