Contralateral Metachronous Hernia Following Negative Laparoscopic Evaluation for Contralateral Patent Processus Vaginalis: A Meta-analysis

ObjectiveOur objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality.BackgroundSystematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated.MethodsAdhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality.Results112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression.ConclusionsThere are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.

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“…The PRISMA flow diagram is illustrated in Fig 1 and excluded studies and reasoning for exclusion are listed in Table 2 below [15–60]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery

2017

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“…Unfortunately, to date, reports on adults have seldom discussed the risk factors for CIH repair. Unlike infants and children, the risk factors associated with and results of CIH repair have been widely discussed [ 4 , 5 ]. Only one study used a non-Medicare claims database to analyze the risk factors for treatment of CIH and showed that an older age and prostate disease were risk factors [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population based cohort study

et al. 2017

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BackgroundTo identify the rate of and risk factors for contralateral inguinal hernia (CIH) after unilateral inguinal hernia repair in adult male patients.MethodsThis retrospective cohort study identified from the Taiwan National Health Insurance Research Database (NHIRD). Information on all adult patients who underwent primary unilateral inguinal hernia repair without any other operation was collected using ICD-9 diagnostic and procedure codes. The exclusion criteria were laparoscopic hernia repair, non-primary repair, complicated hernia, other combined procedures, female and undetermined gender.ResultsA total of 170,492 adult male patients were included, with a median follow-up of 87 months. The overall CIH rate was 10.5%, with a median time of 48 months to a subsequent hernia operation. The 1-year, 2-year, 3-year and 5-year-recurrent rate was 2.6, 3, 4.3, and 6.7% respectively. Further, 3.7% patients who underwent CIH repair had a complicated inguinal hernia. Multivariate analysis demonstrated that age > 45 y, direct hernia, cirrhosis (HR = 1.564), severe liver disease (HR = 1.663), prostate disease (HR = 1.178), congestive heart failure (HR = 1.138), and history of malignancy (HR = 1.116) had a significantly higher risk of CIH repair.ConclusionsAmong adult male patients undergoing long-term follow-up, we identified several significant risk factors for CIH repair. If these risk factors are presented, the surgeon should inform the following risk of CIH repair to patients so that it can be repaired as soon as possible.

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“…Therefore laparoscopy is a sensitive method with which to detect CPPV and a good way to prevent MIH at the expense of an overtreatment of CPPV, but it is not a precise way to predict CIH. Importantly negative evaluation of CPPV does not exclude the possibility of CIH ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

Huang

Yang

et al. 2018

Front. Pediatr.

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Background/purpose: Thickening of the spermatic cord is a clinical sign of an inguinal hernia. We therefore tested whether pre-operative spermatic cord ultrasonography could reduce the incidence of metachronous inguinal hernia (MIH).Methods: Boys under 2 years old with an initial unilateral inguinal hernia were enrolled in this study. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, these patients underwent contralateral groin exploration. Age at initial operation, weight, initial operation side, the sonographic width of the spermatic cord, the operative findings and presence of MIH were recorded, and the relationship among them was studied. Boys in the US group underwent an open herniorrhaphy with pre-operative ultrasound examination; the non-US group included boys who did not undergo a pre-operative ultrasound examination. A receiver operator curve (ROC) analysis was performed to evaluated predictive value of the sonographic width of the spermatic cord for contralateral hernia.Results: A total of 24 months' follow-up data were obtained from 1,793 boys (US group 1,162, non-US group 631). In the US group, the width of the hernia-sided spermatic cord (0.75 ± 0.18 cm) was larger than the normal side (0.37 ± 0.05 cm, P < 0.001). And the width of normal side spermatic cord had no significant difference between the groups regarding other factors such as age and weight. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, the corresponding incidence of CIH was 86.4% (57/66). The width of the spermatic cord predicted the presence of contralateral hernia with ROC area under the curve = 0.943 (95% CI = 0.919–0.966). The total incidence of MIH was 4.1% (74/1793). The incidence of MIH in the US group was 2.2% (25/1162) much lower than 7.8% (49/631) in the non-US group (P < 0.001). If the width of the asymptomatic-sided spermatic cord was 0.5 cm and 0.54 cm, the corresponding sensitivity was 0.682 and 0.294, respectively, the corresponding specificity was 0.991 and 1.000, respectively.Conclusion: If the width of the asymptomatic-sided spermatic cord of boys with initial unilateral inguinal hernia sonographic width was ≥0.5 cm, contralateral groin exploration was recommended, and it help to reduce the incidence of MIH.

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Contralateral Metachronous Hernia Following Negative Laparoscopic Evaluation for Contralateral Patent Processus Vaginalis: A Meta-analysis

Abstract: CMIH following negative laparoscopic evaluation for CPPV was a rare but possible phenomenon. Choosing the transumbilical approach, transinguinal laparoscopy with a large angle, low-pressure pneumoperitoneum, and broad CPPV definition would probably reduce the occurrence of such CMIHs.

Cited by 31 publications

References 25 publications

A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery

A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery

Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population based cohort study

Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

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