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Laparoscopic Extraperitoneal Hernia Repair Versus Open Repair in Boys with Inguinal Hernia: A Meta-Analysis
Po-Lung Cheng1, Yih-Cherng Duh2, Jeng-Jung Chen3
1Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan.
Insights
Laparoscopic hernia repair (LHE) in boys results in fewer testicular complications and less metachronous contralateral inguinal hernia (MCIH) compared to open hernia repair (OH). LHE is a feasible, less invasive option for pediatric inguinal hernia repair.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Surgical outcomes research
Background:
- Pediatric inguinal hernia is a common condition requiring surgical intervention.
- Traditional open hernia repair (OH) is associated with potential testicular complications.
- Laparoscopic hernia repair using the extraperitoneal method (LHE) aims to minimize spermatic cord structure injury.
Approach:
- A comprehensive meta-analysis was conducted on randomized controlled trials (RCTs) and non-RCTs.
- Databases searched include PubMed, EMBASE, and Cochrane Library.
- The primary outcome assessed was testicular complications; secondary outcomes included MCIH, recurrence, and operation time.
Key Points:
- The meta-analysis included 17,555 boys from 26 studies (6 RCTs, 20 non-RCTs).
- LHE demonstrated significantly lower incidence of ascending testis and MCIH compared to OH.
- No significant difference was found in hydrocele, testicular atrophy, or ipsilateral hernia recurrence rates between LHE and OH.
Conclusions:
- LHE offers comparable or reduced testicular complication rates versus OH.
- LHE significantly lowers the incidence of metachronous contralateral inguinal hernia.
- LHE presents a feasible and less invasive surgical option for pediatric inguinal hernia repair.
Objective:
Pediatric inguinal hernia is a common surgical problem in boys. Open hernia repair surgery (OH) has been traditionally used to treat this condition, but it leads to complications, such as testicular complications. Laparoscopic hernia repair by using the extraperitoneal method (LHE) is performed through the percutaneous insertion of sutures and extracorporeal closure of patent vaginalis processus; thus, injury to spermatic cord structures is avoided. However, a meta-analysis comparing LHE and OH is lacking.
Methods:
PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. A meta-analysis of the retrieved studies was performed, and a random-effects model was used to calculate the pooled effect size. The primary outcome was testicular complications, including ascending testis, hydrocele, and testicular atrophy. The secondary outcomes were surgical metachronous contralateral inguinal hernia (MCIH), ipsilateral hernia recurrence, and operation time.
Results:
In total, 6 randomized controlled trials (RCTs) and 20 non-RCTs involving 17,555 boys were included. The incidence of ascending testis (risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.18-0.78; p = 0.008) and MCIH (RR: 0.17, 95% CI: 0.07-0.43; p = 0.0002) was significantly lower in LHE than in OH. The incidence of hydrocele, testicular atrophy, and ipsilateral hernia recurrence did not differ between LHE and OH.
Conclusion:
Compared with OH, LHE led to fewer or equivalent testicular complications without increasing ipsilateral hernia recurrence. Moreover, MCIH incidence was lower in LHE than in OH. Hence, LHE could be a feasible choice with less invasiveness for inguinal hernia repair in boys.
Level Of Evidence:
Treatment study, LEVEL III.
