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Published on: November 12, 2021
Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure
Hiromu Miyake1, Koji Fukumoto1, Masaya Yamoto1
1Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Insights
Laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia shows low recurrence, especially in males under one year. Surgeons should be cautious with young males to prevent recurrence and identify factors for asymptomatic patent processus vaginalis (PPV).
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic percutaneous extraperitoneal closure (LPEC) is increasingly used for pediatric inguinal hernias.
- Recurrence and contralateral metachronous inguinal hernia (CMIH) remain significant concerns with LPEC.
- This study identifies risk factors for recurrence and CMIH in pediatric patients undergoing LPEC.
Purpose of the Study:
- To analyze risk factors associated with recurrence after LPEC for pediatric inguinal hernia.
- To investigate risk factors for contralateral metachronous inguinal hernia (CMIH) in pediatric patients.
- To identify predictors of asymptomatic patent processus vaginalis (PPV) detected during LPEC.
Main Methods:
- Retrospective analysis of 1530 pediatric patients undergoing LPEC for inguinal hernia.
- Mean follow-up of 48 months.
- Intraoperative observation and prophylactic surgery for asymptomatic contralateral patent processus vaginalis (PPV).
Main Results:
- Recurrence rate was 0.48% (8/1653 sides), exclusively in male patients.
- Age less than 1 year was the sole significant risk factor for recurrence in males (HR: 4.54, P=0.04).
- CMIH occurred in 0.22% (3/1382), also only in males.
- 44.6% of patients had asymptomatic contralateral PPV requiring prophylactic LPEC.
- Factors associated with asymptomatic PPV included female sex, age ≥1 year, right-sided hernias, and surgeon experience.
Conclusions:
- Surgeons should exercise caution with young male patients to minimize recurrence risk in LPEC for pediatric inguinal hernia.
- No specific risk factors for CMIH were identified, but factors for asymptomatic PPV were noted.
- Further research is needed to correlate CMIH with identified PPV risk factors.
Background:
The use of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has recently been increasing. Recurrence and contralateral metachronous inguinal hernia (CMIH) are important problems for LPEC. This study analyzed the risk factors for recurrence and CMIH.
Methods:
This study included 1530 patients. The mean follow-up period was 48months. Of 1530 patients, 847 were boys and 683 were girls. The mean age at operation was 3.9years. The asymptomatic contralateral internal ring was routinely observed during the operation, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed.
Results:
Recurrence was seen in 0.48% of patients (8/1653 sides), all of whom were male (P=0.01: male versus female). On multivariate analysis, age less than 1year was the only risk factor for recurrence in male patients (hazard ratio: 4.54, 95% CI: 1.07-19.25, P=0.04). CMIH was seen in 0.22% of the patients (3/1382), again only in male patients (P=0.12: male versus female). As a result of intraoperative observation, 44.6% of patients were confirmed to have an asymptomatic contralateral PPV and underwent prophylactic LPEC. Female, age 1year or older, right side, and surgeon's experience were identified as factors associated with asymptomatic contralateral PPV.
Conclusions:
To prevent recurrence, surgeons need to be careful when operating on young male patients. Whereas no specific factor could be identified as a risk factor for CMIH, some factors associated with asymptomatic PPV were identified. Further study and discussion will be needed to identify correlations between CMIH and these factors for PPV.
Level Of Evidence:
Level III.
