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Open Versus Laparoscopic Inguinal Herniotomy in Children: A Systematic Review and Meta-Analysis Focusing on
Shaoguang Feng1, Lingling Zhao, Zhenqi Liao
1*Department of Pediatric Surgery, The Second Affiliated Hospital of Wenzhou Medical University †Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou ‡Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, Jiangsu, China.
Insights
Laparoscopic herniorrhaphy (LH) offers shorter operative times and fewer complications for pediatric inguinal hernias compared to open herniorrhaphy (OH). Recurrence rates were similar between both surgical approaches.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- The optimal surgical approach for pediatric inguinal hernias remains debated.
- Laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) are common procedures.
- Comparative data on operative time, recurrence, and complications are crucial.
Purpose of the Study:
- To compare laparoscopic versus open herniorrhaphy in children.
- To analyze operative time, recurrence rates, and postoperative complications.
- To conduct a systematic review and meta-analysis of available literature.
Main Methods:
- Systematic search of randomized clinical trials comparing LH and OH.
- Inclusion criteria focused on pediatric inguinal hernia repair.
- Data extraction included operative time, recurrence, and complications.
Main Results:
- Five trials with 553 children analyzed (278 OH, 275 LH).
- LH showed shorter operative times for unilateral (extraperitoneal) and bilateral hernias.
- LH resulted in fewer total and major postoperative complications, particularly in male children. No significant difference in recurrence rates was observed.
Conclusions:
- Laparoscopic herniorrhaphy is favored for bilateral hernias and unilateral hernias via extraperitoneal approaches.
- LH significantly reduces total and major postoperative complications in pediatric inguinal hernia repair.
- Both methods demonstrate comparable recurrence rates.
Purpose:
There is an ongoing debate about whether laparoscopic or open herniorrhaphy (LH or OH) is the best choice for inguinal hernia in children. The aim of this study was to compare both of the surgical strategies as regards operative time, recurrence rate, postoperative complications by means of a systematic review, and meta-analysis of the available literatures.
Methods:
A systematic search for randomized clinical trials comparing OH and LH was conducted. Studies were reviewed for quality, inclusion and exclusion criteria, operative time for bilateral and unilateral hernias, recurrence, and complications.
Results:
Five randomized clinical trials with a total of 553 children (OH 278, LH 275) fulfilled the inclusion criteria and were analyzed in this review. Compared with OH, shorter operative time for unilateral hernias was noted in extraperitoneal approaches' group [95% confidence interval (CI), -6.71 to -3.71; I2=0%] as well as for bilateral hernias (95% CI, -12.18 to -3.79; I2=82%). Besides, less total postoperative complications was found in LH group, especially for major postoperative complications in male children (95% CI, 0.01-0.78; I2=0%). However, no significant difference was observed between LH and OH in patients' recurrence.
Conclusions:
This meta-analysis favors LH in the repair of bilateral hernias and for unilateral hernias in extraperitoneal approaches' group. Total postoperative complications were significantly reduced in LH, especially for major postoperative complications in male children.
