Safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernia in infants younger than 6 months: A comparison with conventional open repair

Abstract

Introduction This study aimed to compare the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR) for inguinal hernia in infants younger than 6 months. Methods The medical records of 202 patients who had undergone LPEC or OR at an age younger than 6 months between 2010 and 2016 were reviewed. Patient characteristics and surgical outcomes were compared between LPEC and OR. Results In total, there were 120 LPEC (76 males, 44 females) and 83 OR (76 males, 7 females) cases. There were no differences in median age, median bodyweight, and presence of incarceration between the two groups (LPEC group: 3 months (range, 0–5 months), 5.7 kg (range, 2.3–9.6 kg), and 13.3%; OR group: 3 months (range, 1–5 months), 5.5 kg (range, 2.1–9.0 kg), and 12.0%). LPEC was completed in all cases without any intraoperative complications or open conversions. In the LPEC group, 60.0% of unilateral hernia patients had a contralateral patent processus vaginalis and underwent prophylactic closure. The incidence of metachronous contralateral hernia was significantly lower in the LPEC group than in the OR group (0% vs 10.0%, P < 0.01). Operative time was significantly shorter during LPEC than during OR (P < 0.01) for male patients. The recurrence rate was lower in the LPEC group (0.83%) than in the OR group (2.4%), but the difference was not significant. Conclusion The present data indicate that LPEC is comparable to OR in terms of safety and efficacy in infants younger than 6 months. Moreover, among the LPEC group, there were fewer incidences of metachronous contralateral hernia, and the procedure had a shorter operative time.

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

“…In our meta-analysis, we included a retrospective study by Zenitani et al that involved patients aged under 6 months. They reported that compared with OHR, LHRE was better in terms of the MCIH incidence and operation time [41]. Additional trials involving patients under 1 year of age should be conducted to further generalize the results.…”

“…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).…”

“…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).…”

“…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).…”

Effects of different anesthetic methods on immune function and oxidative stress in patients undergoing laparoscopic herniorrhaphy.

“…Currently, laparoscopic herniorrhaphy is a commonly adopted method of herniorrhaphy in clinical practice, which has the advantages of less trauma, a clear field of vision, high safety and reliability in tissue separation and mesh placement, and remarkable efficacy. However, all surgery leads to trauma and will cause a stress response, inducing varying degrees of damage to the immune function [ 3 , 4 ]. Different anesthetic methods lead to different stress response intensities and immune function damage [ 5 , 6 ].…”