Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis

Shibuya, Soichi; Imaizumi, Takaaki; Yamada, Susumu; Yoshida, Shizuo; Yamada, Shunsuke; Toba, Yoshie; Takahashi, Toshiaki; Miyazaki, Eiji

doi:10.1007/s00464-021-08354-9

Cited by 15 publications

(34 citation statements)

References 38 publications

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“…Laparoscopic inguinal hernia repair was—unlike in adults [ 9 ]—rare in children and was only increasingly used in females older than 1 year of age. While earlier, smaller, comparisons of the open and laparoscopic approaches using unmatched data reported favourable outcomes for the laparoscopic procedure [ 42 ], a recent study employed propensity-matching and described several downsides of the laparoscopic approach such as always longer anaesthesia times for both uni- and bilateral inguinal hernia repairs and much higher recurrence rate compared to the open approach [ 43 ]. As propensity-matching is thought to increase the precision of a comparison, it might result in more credible data compared to crude comparisons.…”

Section: Discussionmentioning

confidence: 99%

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

et al. 2021

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Background Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children. Methods We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons. Results Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year. Conclusions Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

et al. 2021

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“…This may have influenced the results of the comparison between LPEC and OH. In their recently published paper, Shibuya et al analyzed retrospective data using propensity score‐based methods and a log‐rank test analysis, concluding that LPEC was associated with a higher recurrence rate than OH, although they did not consider a younger age as a significant risk factor of recurrence 26 . Although the paper from Shibuya et al is the only study to indicate a significantly higher recurrence rate in LPEC than in OH, a propensity score‐based technique may be useful for minimizing the effect of the retrospective nature of this study.…”

Section: Discussionmentioning

confidence: 99%

Risks and benefits of pediatric inguinal hernia repair: Conventional open repair vs laparoscopic percutaneous extraperitoneal closure

Kurobe

Sugihara

Harada

et al. 2021

Asian J Endoscop Surgery

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Introduction: Considerable debate exists regarding the benefits of laparoscopic percutaneous extraperitoneal closure (LPEC) over conventional open repair (OR). We assessed the outcomes and feasibility of LPEC compared to OR for pediatric inguinal hernia (IH). Methods: We retrospectively analyzed 570 children who underwent LPEC or OR. Parents decided the operative method after obtaining informed consent. Patient characteristics, operative time, complications and contralateral metachronous IH (CMIH) were compared between the groups.Results: A total of 329 children underwent LPEC and 241 underwent OR. There was no significant difference in the incidence of recurrence or testicular ascent between the LPEC and OR groups (0.3% vs 0.4%, P = 0.825, 0.3% vs 0.8%, P = 0.391, respectively). No testicular atrophy was recognized in either group. One patient with postoperative chronic inguinal pain was recognized in each group. There was no surgical site infection (SSI) in the OR group; however, the LPEC group more frequently demonstrated umbilical port site (UPS)related complications, such as incisional hernia, minor deformity, granuloma formation, cellulitis and superficial SSI. Ten (4.1%) developed CMIH in OR; in contrast, no case of CMIH was experienced after LPEC (P < 0.001). Conclusion:In conclusion, both LPEC and OR are feasible in the management of pediatric IH, because of their high success rates and low risk of complications. LPEC could be the superior procedure with respect to the prevention of CMIH. However, to maximize the merits of LPEC over OR, it is important to reduce UPS-related complications in LPEC. A longer follow-up is needed to assess male fertility in patients who receive LPEC.

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“…A total of 16 studies compared the incidence of metachronous hernia between the LHRE and OHR groups, and 15 of them with a total of 14,416 patients (5207 patients in the LHRE group and 9209 patients in the OHR group) with the diagnosis of unilateral inguinal hernia who received operation were assessed [21,[23][24][25][26][27]29,32,33,36,37,[40][41][42][43]. The pooled result indicated that LHRE resulted in a considerably lower incidence of metachronous hernia compared with OHR (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001; I 2 = 4%; Figure 2).…”

Section: Metachronous Herniamentioning

confidence: 99%

“…A total of 26 studies compared the incidence of ipsilateral recurrence hernia between the LHRE and OHR groups, and the data of 25 of them covered a total of 24,430 patients (12,626 patients in the LHRE group and 11,777 patients in the OHR group) were assessed [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][43]. The incidence of ipsilateral recurrence hernia did not differ between the LHRE and OHR groups (RR: 0.97, 95% CI: 0.59 to 1.60; p = 0.91; I 2 = 44%; Figure 3).…”

Section: Ipsilateral Recurrence Herniamentioning

confidence: 99%

“…In total, 24 studies compared the operation time between the LHRE and OHR groups; 19 of these that clearly described the statistical data of unilateral hernia repair, bilateral hernia repair, or a combination of both were analyzed independently [19][20][21][22][23]25,[27][28][29][30][31][32]35,37,[39][40][41][42]. Overall, the pooled result revealed a significantly shorter operation time in the LHRE group than in the OHR group (WMD: −11.90 min, 95% CI: −16.36 to −7.44; p < 0.00001; I 2 = 99%; Figure 4).…”

Section: Operation Timementioning

confidence: 99%

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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

Huang

Cheng

Hou

et al. 2022

JCM

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Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.

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Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis

Cited by 15 publications

References 38 publications

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Risks and benefits of pediatric inguinal hernia repair: Conventional open repair vs laparoscopic percutaneous extraperitoneal closure

Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

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