Related Experiment Video
Updated: Aug 7, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for
Yi Chen1, Furan Wang2, Hongji Zhong1
1Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
Insights
Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) is effective for pediatric inguinal hernia/hydrocele repair. Utilizing specific techniques like assisted forceps and hydrodissection can minimize complications, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) is a common technique for pediatric inguinal hernia and hydrocele repair.
- Variations in surgical instruments and techniques exist, leading to diverse outcomes in reported SLPEC procedures.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes of SLPEC for pediatric inguinal hernia/hydrocele.
- To identify surgical techniques and instruments associated with reduced complications.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, and Cochrane Library for studies on SLPEC in pediatric patients.
- Data on surgical details and operative outcomes from 37 studies were pooled and analyzed using StataSE 12.0.
Main Results:
- The meta-analysis included 37 studies, with a mean Children's Post-Polysaccharide Vaccine (CPPV) incidence of 29.1%.
- Overall complication rates were low: injury (0.32%), conversion (0.05%), recurrence (0.70%), hydrocele formation (0.23%), knot reaction (0.33%), severe pain (0.05%), and scrotal swelling (0.03%). No testicular atrophy was reported.
- Subgroup analyses revealed that assisted forceps, hydrodissection, and blunt puncture devices correlated with lower injury rates; hydrodissection with lower conversion rates; and assisted forceps, hydrodissection, nonabsorbable sutures, and specific preventive measures with lower recurrence/hydrocele rates and knot reactions.
Conclusions:
- SLPEC is a well-established and safe procedure for pediatric inguinal hernia and hydrocele repair.
- Adoption of assisted forceps, hydrodissection, nonabsorbable sutures, and meticulous technique to avoid ligating unnecessary tissues can significantly decrease intraoperative and postoperative complications.
Background:
Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports.
Methods:
A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0.
Results:
49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures.
Conclusions:
SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.
