Materials and methods
Literature search
Eligibility criteria
Study selection and methodological quality assessment
Data extraction
Statistical analysis
Results
Literature search
Study characteristics
Author | Year | Country | Study design | Patients no. (LH, OH) | Unilateral no. (%) | Bilateral no. (%) | Male no. (%) | Female no. (%) | Age range | Follow-up Mean (SD)/(range) |
---|---|---|---|---|---|---|---|---|---|---|
Celebi et al. | 2014 | Turkey | RCT | 59 (28, 31) | 0 (0) | 59 (100) | 59 (100) | 0 (0) | > 6 yr | 3–24 mo |
Chan et al. | 2005 | Hong Kong | RCT | 83 (41,42) | 80 (96.4) | 3 (3.6) | 67 (80.7) | 16 (19.3) | 3 mo–18 yr | LH: 12.2 (2.8) mo OH: 11.8 (2.5) mo |
Gause et al. | 2016 | USA | RCT | 41 (26, 15) | 27 (65.9) | 14 (34.1) | 31 (75.6) | 10 (24.4) | < 3 yr | 2 yr |
Inal et al. | 2013 | Turkey | RCT | 40 (20, 20) | 40 (100) | 0 (0) | 40 (100) | 0 (0) | 7–14 yr | 24 h |
Koivusalo et al. | 2008 | Finland | RCT | 89 (47, 42) | 89 (100) | 0 (0) | 66 (74.2) | 23 (25.8) | 4 mo–16 yr | 24 mo |
Saranga et al. | 2008 | India | RCT | 69 (35, 34)a | 69 (100) | 0 (0) | 62 (89.9) | 7 (10.1) | < 14 yr | 3.5 mo |
Shalaby et al. | 2012 | Egypt | RCT | 250 (125, 125)b | 53 (21.2) | 92 (36.8) | 179 (71.6) | 71 (28.4) | 14–96 mo | 24 (16–30) mo |
Zhu et al. | 2015 | China | RCT | 102 (53, 49) | 76 (74.5) | 26 (25.5) | 71 (69.6) | 31 (30.4) | 7–63 mo | 6 mo |
Methodological quality
Primary outcome: operative and postoperative complications
Author year | Procedure no. | Perioperative complications | Postoperative complications | Recurrence no. (%) | MCIH rate no. (%) | Presence of CPPV no. (%) | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Injury spermatic vessels/vas deferens no. (%) | Ovarian lesion no. (%) | Bleeding no. (%) | Hematoma/edema no. (%) | Hydrocele no. (%) | Wound infection no. (%) | Iatrogenic testicular ascent no. (%) | Testicular atrophy no. (%) | |||||
Celebi 2014 | LH: 28 | 0 (0) | NA | – | 0 (0) | 3 (10.7) | – | 0 (0) | 0 (0) | 0 (0) | – | – |
OH: 31 | 0 (0) | NA | – | 0 (0) | 0 (0) | – | 0 (0) | 0 (0) | 0 (0) | – | NA | |
Chan 2005 | LH: 41 | – | – | – | – | 1 (2.4) | – | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 12 (29.3) |
OH: 42 | – | – | – | – | 0 (0) | – | 0 (0) | 0 (0) | 0 (0) | 5 (11.9) | NA | |
Gause 2016 | LH: 26 | 0 (0) | 0 (0) | 1 (3.8)b | 0 (0) | 0 (0) | 0 (0) | – | 0 (0) | 1 (3.8) | – | – |
OH: 15 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (6.7) | – | 0 (0) | 0 (0) | – | NA | |
Inal 2013 | LH: 20 | – | NA | – | – | – | – | – | – | – | – | – |
OH: 20 | – | NA | – | – | – | – | – | – | – | – | NA | |
Koivusalo 2008 | LH: 47 | – | – | – | – | – | – | 0 (0) | 0 (0) | 2 (4.3) | 3 (6.4) | 12 (26) |
OH: 42 | – | – | – | – | – | – | 0 (0) | 0 (0) | 1 (2.4) | 2 (4.8) | NA | |
Saranga 2008 | LH: 35 | – | – | 2 (5.7)c | 0 (0) | 2 (5.7) | 0 (0) | – | – | 0 (0) | 0 (0) | 10 (22.2) |
OH: 34 | – | – | 0 (0) | 2 (5.9) | 1 (2.9) | 2 (5.9) | – | – | 0 (0) | 0 (0) | NA | |
Shalabya 2012 | LH: 125 | 0 (0) | 0 (0) | 0 (0) | – | 3/87 (3.4) | – | 0 (0) | 0 (0) | 1 (0.8) | – | – |
OH: 125 | 0 (0) | 0 (0) | 0 (0) | – | 5/92 (5.4) | – | 4/92 (4.4) | 3/92 (3.3) | 3 (2.4) | – | NA | |
Zhu 2015 | LH: 53 | – | – | – | 2 (3.8) | – | – | – | – | 0 (0) | 1 (1.9) | Uncleard |
OH: 49 | – | – | – | 19 (38.8) | – | – | – | – | 0 (0) | 7 (14.3) | NA |
Outcome | Studies, n | Total participants, n | Participants in LH group, n | Participants in OH group, n | Heterogeneity I2, % | Mean difference (95% CI) | Odds ratio (95% CI) | p Value |
---|---|---|---|---|---|---|---|---|
Complications | 693 | 355 | 338 | 61 | 0.50 (0.14 to 1.79) | 0.29 | ||
Complications (only studies with low risk of bias on patient selection) | 634 | 327 | 307 | 51 | 0.33 (0.10 to 1.06) | 0.06 | ||
Recurrence | 693 | 355 | 338 | 0 | 0.88 (0.20 to 3.88) | 0.87 | ||
Recurrence (only studies with low risk of bias on patient selection) | 634 | 327 | 307 | 0 | 0.88 (0.20 to 3.88) | 0.87 | ||
MCIH rate | 343 | 176 | 167 | 52 | 0.28 (0.04 to 1.86) | 0.19 | ||
MCIH rate (only studies that closed a laparoscopically detected CPPV) | 254 | 129 | 125 | 0 | 0.10 (0.02 to 0.58) | 0.01 | ||
Unilateral operation time | 434 | 226 | 208 | 97 | 0.62 (− 5.70 to 6.95) | 0.85 | ||
Unilateral operation time (only studies with low risk of bias on patient selection) | 394 | 206 | 188 | 97 | − 0.72 (− 7.53 to 6.09) | 0.84 | ||
Bilateral operation time | 194 | 93 | 101 | 73 | − 7.19 (− 10.04 to − 4.34) | < .001 | ||
Bilateral operation time (only studies with low risk of bias on patient selection) | 135 | 65 | 70 | 74 | − 7.90 (− 12.49 to − 3.31) | < .001 |
Ipsilateral recurrence rate and MCIH
Operation time
Author year | Closing technique | Trocars | Unilateral operation time, mean (SD), min | Bilateral operation time, mean (SD), min | Length of hospital stay, mean (SD), h | Return to full recovery, mean (SD), h | ||||
---|---|---|---|---|---|---|---|---|---|---|
LH | OH | LH | OH | LH | OH | LH | OH | |||
Celebi 2014 | Intracorporeal purse-string suture | Two 3 mm One 5 mm | NA | NA | 32.7 (3.2) | 38.6 (3) | < 24 | < 24 | 58.8 (18) | 45.6 (12) |
Chan 2005 | Intracorporeal purse-string suture | Two 3 mm One 5 mm | 23.3 (6.3) | 18.4 (5.7) | 34 (6.3) | 39.1 (13.4) | 10.7 (5.3) | 10.3 (4.9) | 48.2 (28.7) | 57.7 (27.5) |
Gause 2016 | Extracorporeal ligation (SEAL) | Unclear | 27.9 (15) | 53.2 (30.4) | 38 (19.9) | 50.4 (19) | Uni: 7 (11.3) Bil: 24 (31.7) | Uni: 7.2 (11.5) Bil: 19.2 (10.8) | Uni: 61 (33.4) Bil: 122.4 (36) | Uni: 78 (78.7) Bil: 103.9 (27.6) |
Inal 2013 | Intracorporeal purse-string suture | Two 3 mm One 5 mm | 28.9 (8.1) | 20.5 (7.4) | NA | NA | – | – | 7.5 (0.4) | 5 (1.4) |
Koivusalo 2008 | Intracorporeal “N”-shaped suture | Three 5 mm | 35 (11) | 18.3 (6.8) | NA | NA | 5.9 (1.9) | 4.3 (1.2) | 57.6 (33.6) | 60 (43.2) |
Saranga 2008 | Intracorporeal “Z” suture | Three 5 mm | 25.3 (13) | 30.7 (10.3) | – | – | < 10 (88.6%) 24 (11.4%) | < 10 (97.1%) 24 (2.9%) | – | – |
Shalaby 2012 | Extracorporeal suturing with Reverdin needle | One 3 mm | 7.6 (3.5)a | 12.8 (4.5) | 11.4 (2.7) | 21.9 (7.2) | 5 (3.2) | 5 (3.2) | <6 | <10 |
Zhu 2015 | Extracorporeal suturing with epidural needle | One 3 mm Two 5 mm | 15.4 (2.1)b | 20.5 (3.7) | 15.4 (2.1) | 20.5 (3.7) | 48 | 84 | – | – |
Length of hospital stay
Time to full recovery
Postoperative pain and pain-medication requirement
Author | Pain assessment | Determine severity of pain | Administration | Timing of pain medication | Pain medication | Patients requiring medication | Doses administered/requestedd | ||
---|---|---|---|---|---|---|---|---|---|
LH | OH | LH | OH | ||||||
Celebi et al. | VAS | VAS (0–10) | Self-administration | During admission | PCA with bolus morphine 10 µg/kg, median (SD) | – | – | A: 8.4 (6.6) R: 8.8 (6.6) | A: 11.9 (5.6) R: 12.5 (10.2) |
After discharge | Ibuprofen 20 mg/kg, median (SD) | – | – | 0.8 (0.8) | 1.3 (1.2) | ||||
Chan et al. | - CHIPPS - CHEOPS | CHIPPS/CHEOPS | CHIPPS ≥ 4 CHEOPS ≥ 5 | During admission | Acetaminophen (dose/patient), mean (SD) | – | – | 0.5 (0.8) | 1.1 (1.2) |
Gause et al. | FLACC | – | FLACC > 4 | During admission | Acetaminophen 15 mg/kg, mean (SD) | – | – | Uni: 5.3 (5.9) Bil: 9.6 (7.3) | Uni: 9 (9.7) Bil: 4.8 (1.7) |
During admission | Fentanyl 0.5 µg/kgc % patients | Uni: 50% Bil: 75% | Uni: 57.1% Bil: 50% | Uni: 0.8 (0.9) Bil: 0.8 (0.5) | Uni: 0.9 (1.1) Bil: 0.5 (0.6) | ||||
Inal et al. | VAS | VAS (0–10) | Self-administration | During admission | PCA with bolus morphine 10 µg/kg, mean (SD) | – | – | A: 5.4 (6.1) R: 10.7 (7.3) | A: 8.8 (5.8) R: 33.2 (6.2) |
Koivusalo et al. | - Modified OPS - Pain scalea | OPS (0–9) Pain Scale (0–3) | Judged by attending nurseb | During admission | Fentanyl 1.0 µg, No. (%) patients | 37 (79) | 20 (48) | 37 (79) | 20 (48) |
After discharge | Ibuprofen 20 mg/kg, median (range) | – | – | 1 (0–3) | 1 (0–5) | ||||
Saranga et al. | - CHIPPS - CHEOPS - VRS | - Nil - Mild - Moderate | Unclear | During admission | Acetaminophen 15 mg/kg, No. (%) patients - Nil pain - Mild pain - Moderate pain | 2 (6) 30 (86) 3 (8) | 0 (0) 32 (94) 2 (6) | – | – |
Shalaby et al. | – | – | – | – | – | – | – | – | – |
Zhu et al. | – | – | – | – | – | – | – | – | – |
Cosmetic results
Author | Measurement | Measured by | Scoring system | Type of score | Timing of score | Wound score, mean (SD)/median (range) | Cosmesis problems, no. (%) | ||
---|---|---|---|---|---|---|---|---|---|
LH | OH | LH | OH | ||||||
Celebi et al. | Recovery and wound appearance | Parents | 70: fair 80: good 90: very good 100: excellent | Score 70–100 | 3 mo | 89 (4.2) | 78 (6.7)* | – | – |
Chan et al. | Recovery and wound appearance | Parents | 70: fair 80: good 90: very good 100: excellent | Score 70–100 | 7 d | 95.4 (6) | 90.2 (6)* | Hypertrophic scar: 1 (2.4) | Hypertrophic scar: 2 (4.8) Stitch granuloma: 1 (2.4) |
Gause et al. | Wound appearance | Parents | 1 (not satisfied) 2 3 (adequate) 4 5 (very satisfied) | Score 1–5 | 7 d | Uni: 4.9 (0.4) Bil: 4.9 (0.3) | Uni: 4.4 (0.8) Bil: 5 (0) | – | – |
Inal et al. | – | – | – | – | – | – | – | – | – |
Koivusalo et al. | Cosmetic result | Patients/parents, attending nurse and surgeon | 0: unsatisfactory 1: satisfactory 2: good 3: excellent | Score 0–9 | a) 6 mo b) 2 yr | a) 7 (3–9) b) 7 (5–9) | 7 (3–9) 9 (5–9) | – | – |
Saranga et al. | Scar cosmetics | Not clear | Good Excellent | Excellent/good Patients, no. (%) | Average 3.5 mo | Good: 0 (0) Excellent: 35 (100) | 34 (100) 0 (0) | – | – |
Shalaby et al. | Scar cosmetics | Parents | Ugly scar | Ugly scar Patients, no. (%) | > 6 mo | – | – | Ugly scar: 0 (0) | Ugly scar: 5 (4)* |
Zhu et al. | – | – | – | – | – | – | – | – | – |