P1.046: High Ligation versus Floor Repair for Adolescent Inguinal Hernias: A Matched Comparison of Recurrence and Complications

Background: The optimal surgical approach for inguinal hernias in adolescent patients remains an area of debate. While high ligation (HL) for indirect hernias is standard in younger children, floor repair (FR), usually with mesh, is preferred in adults due to the higher incidence of direct hernias and weakness of the abdominal wall. This study compares recurrence rates and perioperative complications between HL and FR in adolescent patients.

Methods: A retrospective study was performed on 10-17 year old patients who underwent inguinal hernia repair within a single hospital system between 7/2013 and 6/2023. Operations were performed by pediatric surgeons, pediatric urologists, or general surgeons. HLs were then matched 2:1 to FRs based on patient sex, BMI, and age. Matching was validated using covariate matching model and post-matching demographic comparison.

Results: There were 159 patients included in analysis after matching; 106 HL and 53 FR. Median BMI was 20.8kg/m2 (FR) vs. 20.3 (HL; p=0.6). Median age was 15 years in both groups (p=0.5). Median follow-up duration was 2.4 years for HL and 1.4 years for FR (p=0.12). HL was more likely to be performed open (83% [88/106]) compared to FR (72% [38/53]; p< 0.004). Of the 18 minimally-invasive HLs, 13 (72%) were performed using Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) technique. Most minimally-invasive FRs were performed via either TEP (27%, [4/15]) or TAPP (47%, [7/15]). Median operative time for HL was 36 minutes, shorter than FR (median 74 minutes; p< 0.001; Figure). There was no significant difference in recurrence between HL (9% [10/106]) and FR (4% [2/53]; p=0.340). There were no differences in perioperative complications between HL (4.7% [5/106]) and FR (1.9% [2/53], p>0.9). The most common complication was chronic pain >3 months, occurring in five (3%) repairs overall.

Conclusion: When matched for demographics, HL and FR had similar recurrence and complication rates. Floor repair with mesh is likely not required for every adolescent patients. Further investigation into preoperative factors, anatomy, and risk factors may help refine patient-specific surgical decision making.