Key messages
- The number of hernias that come back (recurrence) is similar after open and laparoscopic (keyhole) surgery in children.
- Children who had keyhole surgery had fewer mild problems (e.g. impaired wound healing or swelling) after surgery than children who had open surgery.
What is an inguinal hernia?
An inguinal hernia is a lump or swelling in the groin (between the belly and the thighs) caused by tissue pushing through a weak spot in the muscles. Symptoms might be a bulge in the groin region, a full, round belly, and vomiting. Around 6.6% of boys and 0.7% of girls are affected by an inguinal hernia between birth and 15 years of age. It is one of the most common conditions that requires surgical treatment in children. Organs in the belly (e.g. the bowel) may prolapse into the hernia and risk being trapped (called 'incarceration') with subsequent strangulation of the organs. The rate of incarceration in infants and young children with inguinal hernia is around 12%. Therefore, when a hernia is diagnosed, a repair is recommended in all cases.
What are the treatment options?
Doctors can treat a hernia with either laparoscopic surgery (keyhole surgery with a camera and small tools through tiny cuts in the belly region) or open surgery (a small cut in the groin). Both aim to close the hernia opening and stop it from coming back.
What did we want to find out?
We wanted to know if one surgical method is better than the other for preventing the hernia from coming back, reducing problems during or after the operation, and lessening pain after surgery.
What did we do?
We searched for studies that compared keyhole and open hernia surgery in children. We included only studies where children were randomly assigned to one type of surgery or the other. We looked at how often hernias came back, whether there were any problems during or after the surgery, how much pain children had, and how long they were followed up for after the surgery.
What did we find?
We found 12 studies comparing keyhole and open hernia surgery in 1247 children. The results showed that both types of surgery had similar rates of hernia recurrence, i.e. hernias coming back. However, we are not very confident that this portrays the reality very well, as there were only a few recurrences in both groups. No serious injuries during surgery were reported, and no children had to switch from keyhole to open surgery (but we are also not very confident in these results because there were no events to count). Children who had keyhole surgery had fewer mild problems (e.g. impaired wound healing or swelling) compared to those who had open surgery. We found no clear difference in short-term pain between the two methods (but we have very low confidence in this finding). No studies looked at long-term pain.
What are the limitations of the evidence?
Some studies did not clearly report how children were chosen or followed up. Pain and complications were not always measured the same way. Most studies had short follow-up times, and no studies reported on pain lasting longer than a few weeks. Overall, there are not many studies that exist which compare keyhole and open hernia surgery in children. Therefore, additional research is needed to draw more reliable conclusions.
What does this mean?
Both keyhole and open surgery may be similar in terms of their benefits and risk of harmful events for treating inguinal hernias in children. Keyhole surgery may lead to fewer minor problems after surgery. More high-quality studies are needed to help us understand the long-term effects and how the two methods compare over time.
How up to date is this evidence?
Our latest search was conducted in June 2025.
Read the full abstract
Objectives
To compare the benefits and harms of laparoscopic versus open repair in paediatric inguinal hernia.
Search strategy
We searched CENTRAL, MEDLINE, and Embase in May and June 2025. As the first laparoscopic repair of paediatric inguinal hernia was conducted in 1993, the search focused on studies published from that year onwards. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry. We screened reference lists of included studies and related systematic reviews for additional references. We also searched PubMed for retractions and errata (none identified).
Authors' conclusions
Laparoscopic and open inguinal hernia repair in children appears to result in comparable recurrence rates. There are inadequate data to draw conclusions about the effects of laparoscopic compared to open surgery on intraoperative injuries, Clavien-Dindo grade 3a and 5, or acute postoperative pain. There may be little to no difference between laparoscopic and open surgery concerning Clavien-Dindo grades 3b to 4. Furthermore, no studies evaluated chronic pain and the heterogeneity in surgical techniques suggests caution is needed in the generalisation of findings. The available data are of very low to low certainty, so we are not able to draw conclusions about the effects of laparoscopic versus open paediatric inguinal hernia repair. Future high-quality trials with standardised outcome reporting are needed.
Funding
We have not received funding for this systematic review.
Registration
Protocol (2024) DOI: 10.1002/14651858.CD015470.
