Related Experiment Video
Updated: Jan 13, 2026
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Laparoscopic percutaneous extraperitoneal closure versus open repair in pediatric inguinal hernia: a systematic
Masaya Yamoto1, Toshiaki Takahashi2, Yoshiki Morotomi3
1Department of Pediatric Surgery, Osaka City General Hospital, 2 Chome-13-22 Miyakojimahondori, Miyakojima Ward, Osaka, 534-0021, Japan. ped.surg1018@gmail.com.
Insights
Laparoscopic percutaneous extraperitoneal closure (LPEC) offers comparable recurrence rates to open hernia repair (OHR) in children. LPEC reduces contralateral hernias and testicular ascent, making it a safe and effective first-line treatment.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Hernia repair
Background:
- Pediatric inguinal hernia is a common surgical condition.
- Open hernia repair (OHR) is the traditional standard.
- Laparoscopic percutaneous extraperitoneal closure (LPEC) is a minimally invasive alternative.
Purpose of the Study:
- To systematically compare clinical outcomes of LPEC versus OHR in pediatric patients.
- Evaluate recurrence, contralateral metachronous hernia (CMH), and postoperative testicular ascent.
- Assess operative time for unilateral and bilateral repairs.
Main Methods:
- Systematic review and meta-analysis following PRISMA 2020 guidelines.
- Searched PubMed, Ichushi-Web, and Google Scholar up to May 2022.
- Included randomized and observational studies comparing LPEC and OHR in children under 18.
Main Results:
- Ten studies involving nearly 15,000 children were analyzed.
- Recurrence rates were similar between LPEC and OHR.
- LPEC showed significantly lower risks of CMH and testicular ascent.
- Bilateral LPEC repairs were faster than OHR.
Conclusions:
- LPEC demonstrates equivalent recurrence outcomes to OHR.
- LPEC effectively reduces contralateral hernias and testicular ascent.
- LPEC is a safe, effective, and potentially more efficient first-line option for pediatric inguinal hernia.
Purpose:
Pediatric inguinal hernia is one of the most frequent surgical conditions in children. Conventional open repair (OHR) has been regarded as the standard approach for decades; however, laparoscopic percutaneous extraperitoneal closure (LPEC), first described in Japan, has emerged as a minimally invasive alternative. This study aimed to systematically compare the clinical outcomes of LPEC with those of OHR in pediatric patients.
Methods:
A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines (PROSPERO CRD42022349660). PubMed, Ichushi-Web, and Google Scholar were searched up to May 2022. Eligible studies included randomized and observational comparisons of LPEC (or equivalent percutaneous closure techniques) versus OHR in patients under 18 years. Outcomes assessed were recurrence, contralateral metachronous hernia (CMH), postoperative testicular ascent, and operative time for unilateral and bilateral repair. Study quality was evaluated using ROBINS-I, and certainty of evidence graded using GRADE methodology. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated.
Results:
Ten studies with nearly 15,000 children were included. Recurrence did not differ significantly between LPEC and OHR (OR 1.34, 95% CI 0.84-2.16; I2 = 0%). LPEC was associated with significantly lower risk of CMH (OR 16.53, 95% CI 10.13-26.98; I2 = 0%) and testicular ascent (OR 2.51, 95% CI 1.11-5.67; I2 = 0%). Unilateral LPEC required slightly longer operative time (MD + 3.11 min, 95% CI 2.53-3.70), while bilateral repairs were modestly faster (MD -6.21 min, 95% CI -8.02 to -4.40).
Conclusions:
LPEC achieves recurrence outcomes equivalent to OHR while reducing contralateral hernia and testicular ascent, and improving efficiency in bilateral repairs. These findings support LPEC as a safe and effective first-line option for pediatric inguinal hernia.
