Laparoscopic Extraperitoneal Hernia Repair Versus Open Repair in Boys with Inguinal Hernia: A Meta-Analysis |
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Affiliation: | 1. Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan;2. Division of Pediatric Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan;3. MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan;4. Department of Pediatrics, Hsinchu Municipal MacKay Children''s Hospital, Hsinchu City, Taiwan;5. Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan;6. Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan |
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Abstract: | ![]() ObjectivePediatric inguinal hernia is a common surgical problem in boys. Open hernia repair surgery (OH) has been traditionally used to treat this condition, but it leads to complications, such as testicular complications. Laparoscopic hernia repair by using the extraperitoneal method (LHE) is performed through the percutaneous insertion of sutures and extracorporeal closure of patent vaginalis processus; thus, injury to spermatic cord structures is avoided. However, a meta-analysis comparing LHE and OH is lacking.MethodsPubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. A meta-analysis of the retrieved studies was performed, and a random-effects model was used to calculate the pooled effect size. The primary outcome was testicular complications, including ascending testis, hydrocele, and testicular atrophy. The secondary outcomes were surgical metachronous contralateral inguinal hernia (MCIH), ipsilateral hernia recurrence, and operation time.ResultsIn total, 6 randomized controlled trials (RCTs) and 20 non-RCTs involving 17,555 boys were included. The incidence of ascending testis (risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.18–0.78; p = 0.008) and MCIH (RR: 0.17, 95% CI: 0.07–0.43; p = 0.0002) was significantly lower in LHE than in OH. The incidence of hydrocele, testicular atrophy, and ipsilateral hernia recurrence did not differ between LHE and OH.ConclusionCompared with OH, LHE led to fewer or equivalent testicular complications without increasing ipsilateral hernia recurrence. Moreover, MCIH incidence was lower in LHE than in OH. Hence, LHE could be a feasible choice with less invasiveness for inguinal hernia repair in boys.Level of EvidenceTreatment study, LEVEL III. |
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Keywords: | Male Inguinal hernia Laparoscopy Extraperitoneal Meta-analysis |
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