Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis

Kelly Dreuning, Sanne Maat, Jos Twisk, Ernest van Heurn, Joep Derikx, Kelly Dreuning, Sanne Maat, Jos Twisk, Ernest van Heurn, Joep Derikx

Abstract

Background: Laparoscopic inguinal hernia repair in children is increasingly performed as it allows contralateral inspection and potentially results in shorter operation time and less complications. Evidence from meta-analyses of randomized controlled trials (RCTs) regarding the superiority of laparoscopic versus open hernia repair is lacking.

Methods: A systematic literature search was performed querying PubMed, Embase, MEDLINE, and the Cochrane Library databases. RCTs comparing laparoscopic with open hernia repair in children were considered eligible, without year and language restrictions. Cochrane Risk of Bias tool was used for quality assessment. Data were pooled using a random-effects model. Subgroup analyses were performed according to the laparoscopic suturing technique (i.e., intracorporeal or extracorporeal).

Results: Eight RCTs (n = 733 patients; age range 4 months-16 years) were included in this meta-analysis. Laparoscopic (LH) and open (OH) hernia repair was performed in 375 and 358 patients, respectively. Complications (seven RCTs, n = 693; pooled OR 0.50, 95% CI 0.14 to 1.79), recurrences (seven RCTs, n = 693; pooled OR 0.88, 95% CI 0.20 to 3.88), and MCIH rates (four RCTs, n = 343; pooled OR 0.28, 95% CI 0.04 to 1.86) were not different between the groups. LH resulted in shorter bilateral operation time (Five RCTs, n = 194; weighted mean difference (WMD) - 7.19, 95% CI - 10.04 to - 4.34). Unilateral operation time, length of hospital stay, and time to recovery were similar. There was insufficient evidence to assess postoperative pain and wound cosmesis, and evidence of substantial heterogeneity between the included studies. Subgroup analyses demonstrated less complications and shorter unilateral operation time for extracorporeal suturing and shorter length of hospital stay for intracorporeal suturing.

Conclusions and relevance: No definite conclusions to decide on the superiority of one of either treatment strategies can yet be drawn from the available literature. There was evidence of substantial heterogeneity and the clinical relevance of most estimated effects is very limited.

Keywords: Child; Hernia repair; Hernia, inguinal; Laparoscopy.

Conflict of interest statement

Drs. Kelly Dreuning, Sanne Maat, Jos Twisk, Ernest van Heurn, and Joep Derikx have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Meta-analysis of operative and postoperative complications, recurrence rate and metachronous contralateral inguinal hernia (MCIH) rate, and cosmetic problems between laparoscopic (LH) and open (OH) inguinal hernia repair. A Operative and postoperative complications; B recurrence; C MCIH; D problems with wound cosmesis. Proportionally sized boxes represent the weight of each study; diamond shows the pooled odds ratio; LH laparoscopic hernia repair, OH open hernia repair, M–H, Mantel–Haenszel, CI confidence interval
Fig. 1
Fig. 1
Meta-analysis of operative and postoperative complications, recurrence rate and metachronous contralateral inguinal hernia (MCIH) rate, and cosmetic problems between laparoscopic (LH) and open (OH) inguinal hernia repair. A Operative and postoperative complications; B recurrence; C MCIH; D problems with wound cosmesis. Proportionally sized boxes represent the weight of each study; diamond shows the pooled odds ratio; LH laparoscopic hernia repair, OH open hernia repair, M–H, Mantel–Haenszel, CI confidence interval
Fig. 2
Fig. 2
Meta-analysis of continuous outcomes between laparoscopic versus open inguinal hernia repair. A Operation time (min) unilateral hernia repair; B operation time (min) bilateral hernia repair; C length of hospital stay (h); D time to full recovery (h); E doses of pain medication administered; F cosmetic appearance; proportionally sized boxes represent the weight of each study; diamond shows the pooled weighted mean difference; LH laparoscopic hernia repair, OH open hernia repair, IV inverse variance, CI confidence interval
Fig. 2
Fig. 2
Meta-analysis of continuous outcomes between laparoscopic versus open inguinal hernia repair. A Operation time (min) unilateral hernia repair; B operation time (min) bilateral hernia repair; C length of hospital stay (h); D time to full recovery (h); E doses of pain medication administered; F cosmetic appearance; proportionally sized boxes represent the weight of each study; diamond shows the pooled weighted mean difference; LH laparoscopic hernia repair, OH open hernia repair, IV inverse variance, CI confidence interval
Fig. 2
Fig. 2
Meta-analysis of continuous outcomes between laparoscopic versus open inguinal hernia repair. A Operation time (min) unilateral hernia repair; B operation time (min) bilateral hernia repair; C length of hospital stay (h); D time to full recovery (h); E doses of pain medication administered; F cosmetic appearance; proportionally sized boxes represent the weight of each study; diamond shows the pooled weighted mean difference; LH laparoscopic hernia repair, OH open hernia repair, IV inverse variance, CI confidence interval

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Source: PubMed

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