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Laparoscopic hernia repair in children: does recreating the open operation improve outcomes? A systematic review
Ayman Goneidy1, Christian Verhoef1, Nick Lansdale1,2
1Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Insights
Dividing the hernia sac during laparoscopic inguinal hernia repair significantly lowers recurrence rates compared to simple ligation. This technique, laparoscopic sac division and suture ligation (LSDS), improves surgical outcomes in pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair is increasingly used in children, but recurrence rates vary.
- Different laparoscopic techniques may explain these outcome discrepancies.
Approach:
- A systematic review and meta-analysis compared laparoscopic suture ligation alone (LS) with laparoscopic sac division and suture ligation (LSDS).
- PRISMA guidelines were followed, and studies with less than 6 months follow-up were excluded.
Key Points:
- Analysis included 8,518 LS repairs and 6,272 LSDS repairs.
- Laparoscopic sac division and suture ligation (LSDS) showed a significantly lower recurrence rate (OR 0.51).
- No significant differences were observed in testicular ascent or atrophy rates between the two techniques.
Conclusions:
- Recreating the open surgical approach by dividing the hernia sac before ligation improves outcomes.
- Laparoscopic sac division and suture ligation is a superior technique for reducing recurrence in pediatric inguinal hernia repair.
Purpose:
The use of laparoscopy for paediatric inguinal hernia repairs has increased significantly over the past 2 decades. However, there is significant variation in the reported recurrence rates in the literature, with many studies reporting higher rates than the open operation. This may be explained by the range of different techniques currently included under the term laparoscopic inguinal hernia repair. The purpose of this study is to determine whether dividing the hernia sac before ligation improves surgical outcomes following a paediatric laparoscopic inguinal hernia repair compared to ligation alone.
Methods:
A systematic review of the literature was performed following PRISMA guidelines of all studies reporting the outcomes following paediatric laparoscopic inguinal hernia repair where the technique was recorded as laparoscopic suture ligation alone (LS) or laparoscopic sac division and suture ligation (LSDS). Studies were assessed for risk of bias and exclusion criteria included reported follow-up of less than 6 months.
Results:
A total of 8518 LS repairs and 6272 LSDS repairs were included in the final analysis. LSDS repair was associated with a significantly lower recurrence rate (odds ratio 0.51, 95% CI 0.36-0.71, p = 0.001). There was no significant difference in the rates of testicular ascent or atrophy.
Conclusion:
Recreating the open operation by hernia sac division followed by suture ligation significantly reduces the risk of hernia recurrence.
