Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 9, September 2011, Pages 1824-1834
Journal of Pediatric Surgery

Review article
Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis

https://doi.org/10.1016/j.jpedsurg.2011.04.001Get rights and content

Abstract

Purpose

Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH.

Methods

Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables.

Results

Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications.

Conclusions

Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH.

Section snippets

Literature search

Because the current study was a systemic review and meta-analysis based on the published articles, the consents of patients and approval of internal review boards were not included. All published studies until July 30, 2010, were searched with the terms laparoscopy, laparoscopic herniorrhaphy, pediatric inguinal hernia, and open herniorrhaphy from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases, without lower date limit. After identifying

Study characteristics

One hundred thirty-eight studies were initially found to report the LH in the management of PIH using the keywords laparoscopy and pediatric inguinal hernia. One hundred twenty-eight studies were published as complete articles and 10 as abstracts. After screening all titles and abstracts, the number of studies was reduced to 37 by limiting the inclusion criteria as laparoscopic herniorrhaphy, open herniorrhaphy, and pediatric inguinal hernia. After independent review, 23 publications dealing

Discussion

In recent years, LH has been evolved as a minimally invasive technique for PIH [7], [8]. In some centers, inguinal hernias have been treated routinely by the laparoscopic method, which is possible to discover the contralateral inguinal orifice [15]. Recent evidences show the feasibility of laparoscopic operations for incarcerated inguinal hernia [22], [23] and elective and complicated inguinal hernias [22]. Some authors prefer the reduction of incarcerated or irreducible inguinal hernia under

Acknowledgment

This work was supported by the National Natural Science Foundation of China (no. 30200284, no. 30600278, no. 30772359, no. 81071997, no. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025).

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    Supported by the National Natural Science Foundation of China (no. 30200284, no. 30600278, no. 30772359, no. 81071997, no. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025).

    1

    Yang C. and Zhang H. contributed equally to this work.

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