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Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and
Chunlei Yang1, Huanyu Zhang, Jiarui Pu
1Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Insights
Laparoscopic herniorrhaphy (LH) is effective for bilateral pediatric inguinal hernias (PIHs), reducing operative time and metachronic hernia rates compared to open herniorrhaphy (OH). Further trials are needed to confirm LH
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Pediatric inguinal hernias (PIHs) are common, with open herniorrhaphy (OH) as the traditional approach.
- Laparoscopic herniorrhaphy (LH) offers a minimally invasive alternative, but its benefits over OH are debated.
Purpose of the Study:
- To critically evaluate existing literature comparing the efficacy of laparoscopic herniorrhaphy (LH) versus open herniorrhaphy (OH) for pediatric inguinal hernias (PIHs).
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational clinical studies (OCSs) published up to July 30, 2010.
- Searched major databases including Medline, Embase, Ovid, Web of Science, and Cochrane.
- Analyzed dichotomous variables using odds ratios (ORs) and continuous variables using weighted mean differences (WMDs).
Main Results:
- Included 3 RCTs and 4 OCSs (1543 LH cases, 657 OH cases).
- LH demonstrated significantly shorter operative times for bilateral PIHs (WMD = -11.14; P = .02) and a lower rate of metachronic contralateral hernias (OR = 0.26; P = .01) compared to OH.
- No significant differences were found in operative time for unilateral hernias, patient age, sex, hospital stay duration, return to activity, recurrence, or complication rates.
Conclusions:
- Laparoscopic herniorrhaphy (LH) is superior to open herniorrhaphy (OH) for bilateral pediatric inguinal hernias (PIHs), offering reduced operative time and fewer metachronic contralateral hernias.
- LH shows comparable outcomes to OH for unilateral PIHs regarding operative time, hospital stay, recurrence, and complications.
- Further high-quality RCTs with standardized reporting are recommended to definitively establish the efficiencies of LH in managing PIHs, acknowledging potential publishing bias.
Purpose:
Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH.
Methods:
Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables.
Results:
Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = -11.14; 95% confidence interval [CI], -20.61 to -1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications.
Conclusions:
Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH.
