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The International Pediatric Endosurgery Group Evidence-Based Guideline on Minimal Access Approaches to the Operative
Dafydd A Davies1, Drew A Rideout2, Simon A Clarke3
1Department of Surgery, IWK Health Centre, Halifax, Canada.
Insights
Minimally invasive surgery (MIS) for pediatric inguinal hernia repair (IHR) offers shorter operative times and fewer complications compared to open surgery. Recurrence rates are similar, establishing MIS as a safe and effective IHR method with proper training.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Minimally invasive surgery (MIS) for pediatric inguinal hernia repair (IHR) has a history spanning over 20 years.
- The International Pediatric Endosurgery Group (IPEG) prioritized MIS IHR for its 2016 evidence-based review.
- A comprehensive literature search was conducted to gather relevant data.
Purpose of the Study:
- To conduct an evidence-based review of minimally invasive surgery (MIS) for pediatric inguinal hernia repair (IHR).
- To evaluate the safety, efficacy, and outcomes of MIS IHR compared to traditional open repair.
- To provide recommendations based on the highest available levels of evidence.
Main Methods:
- Systematic review of English language articles published between January 1, 2009, and December 31, 2015.
- Searches were performed across major databases including PubMed, Cochrane Reviews, ClinicalTrials.gov, Google Scholar, and EMBASE.
- Inclusion criteria focused on Level 1a and 1b evidence.
Main Results:
- Level 1a and 1b evidence indicates shorter operative times and lower postoperative complication rates for MIS IHR compared to open repair.
- Recurrence rates were found to be similar between MIS and open IHR methods (Level 1a and 1b evidence).
- No Level 1 evidence supports specific MIS techniques or the routine management of contralateral patent processus vaginalis during laparoscopy.
Conclusions:
- MIS repair is a safe and effective method for pediatric inguinal hernia repair (IHR).
- Advantages of MIS include reduced operative time and fewer postoperative complications, particularly in experienced hands.
- Proper training and mentorship are crucial for successful implementation of MIS IHR.
Abstract:
Minimally invasive surgery (MIS) for inguinal hernia repair (IHR) in children has been reported for more than two decades. The International Pediatric Endosurgery Group (IPEG) Evidence-Based Review Committee chose MIS IHR as the inaugural topic for review and presentation at the 2016 IPEG annual meeting. English language articles published between January 1, 2009, and December 31, 2015, were reviewed and included in this evidence-based review after searching PubMed, Cochrane Reviews, ClinicalTrials.gov, Google Scholar, and EMBASE. Level 1a and 1b evidence supports the recommendations that operative time for bilateral IHRs should be considered shorter and postoperative complications rates should be considered lower in MIS repair over open. Recurrence rates are similar between the two methods (level 1a and 1b evidence). No level 1 evidence exists to support one MIS technique over another or that operating on a detected contralateral patent processus vaginalis during laparoscopy makes any difference in long-term outcome to the patient. The advantages of lower postoperative complications and shorter operative times have been found in studies of surgeons experienced in MIS repair and differences were small. The evidence in this review supports that MIS repair is a safe, effective method of IHR with proper training and mentorship.
