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Laparoscopic vs. laparoscopically assisted pediatric inguinal hernia repair: a systematic review
Maria Petridou1, Michael Karanikas2, Christos Kaselas3
1Pediatric Surgery Department, Hippokrateio General Hospital, Thessaloniki, Greece.
Insights
This review compares totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR) for pediatric inguinal hernias. Both methods show similar effectiveness and safety, with comparable recurrence and complication rates.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Pediatric inguinal hernias are common, necessitating effective surgical repair techniques.
- Laparoscopic approaches offer potential benefits over open surgery, but optimal technique remains debated.
- Totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR) are two primary laparoscopic principles.
Approach:
- A systematic literature review was conducted using PubMed, Embase MEDLINE, and Cochrane databases.
- Studies published within the last 20 years comparing LR and LAR for pediatric inguinal hernia repair were included.
- Statistical analysis (Fischer's exact and Student's t test) assessed outcomes like recurrence, complications, and operative time.
Key Points:
- Recurrence rates were statistically similar between LR (1.68%) and LAR (1.59%).
- Transient hydrocele was more frequent in LR (3.17%) compared to LAR (1.01%).
- Wound healing issues were more common in LAR (1.17%) versus LR (0.30%).
- Operative times were shorter in LAR for both unilateral and bilateral cases, though not statistically significant.
Conclusions:
- Both LR and LAR are equally effective and safe for pediatric inguinal hernia repair.
- The choice between LR and LAR may depend on balancing the risk of transient hydrocele (higher in LR) against wound healing problems (higher in LAR).
- Further research may clarify optimal patient selection for each laparoscopic technique.
Abstract:
This systematic review aims to compare the two major principles of laparoscopic pediatric inguinal hernia repair: totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR), to find out the optimal approach for pediatric patients. A systematic literature search was performed via Pubmed, Embase MEDLINE, and Cochrane databases on all studies published in the last 20 years reporting outcomes on these principles including recurrences, complications, and operative time. Prospective studies for either principle or retrospective comparative studies were considered eligible. Fischer's exact and Student's t test were used for statistical analysis with p value < 0.05 considered statistically significant. Twenty-one studies, including two thousand one hundred and ninety-six patients (LR: 1008), of ages ranging from 9 days to 18 years-old and a male to female ratio of 2.55:1, met our inclusion criteria. Follow-up period varied from 3 months to 8 years. Recurrence rates were similar between the two categories (LR: 1.68% vs. LAR: 1.59%, p > 0.05). As regards post-operative complications, transient hydrocele development was higher in laparoscopic repairs (LAR: 1.01% vs. LR: 3.17% p < 0.005) while wound healing problems were more frequent in laparoscopically assisted repairs (LAR: 1.17% vs. LR: 0.30%, p = 0.019). Mean operative time was lower in laparoscopically assisted repairs both in unilateral (LAR: 21.49 ± 13.51 vs. LR: 29.73 ± 11.05, p = 0.131) and bilateral cases (LAR: 28.01 ± 15.08 vs. LR: 39.48 ± 16.35, p = 0.101) but without statistically significant difference. Both principles are equally effective and safe as their recurrence and overall complications rates are equivalent. Transient hydrocele occurs more often in laparoscopic repairs while wound healing problems are associated mostly with laparoscopically assisted repairs.
