Download PDF
Eur J Pediatr Surg 2023; 33(05): 414-421
DOI: 10.1055/a-1958-7830
Original Article

Laparoscopic versus Open Incarcerated Inguinal Hernia Repair in Children: A Systematic Review and Meta-Analysis

Syukri Ahmad Zubaidi 
1   Division of Paediatric Surgery, Department of General Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
,
Don Evana Ezrien
1   Division of Paediatric Surgery, Department of General Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
,
Yong Chen
2   Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
,
Shireen Anne Nah
3   Faculty of Medicine, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Laparoscopic hernia repair (LH) is reported to have superior outcomes in pediatric inguinal hernia repair, but its advantages in incarcerated inguinal hernia (IIH) are not defined. We compare the outcomes of LH versus open hernia repair (OH) for pediatric IIH.

Methods We performed a systematic review on all published analyses of LH versus OH for IIH. We identified studies published in 2000 to 2018 from Medline, PubMed, Embase, Google Scholar, and Cochrane databases. We included only studies that compared both surgical techniques on children aged 18 years or younger. Search terms were variations of “incarcerated inguinal hernia,” “hernia repair,” “laparoscopy,” and “child.” We categorized complications as major (testicular atrophy, ascending testis, recurrence, iatrogenic visceral injury) and minor (wound infection). Heterogeneity was assessed using I2; meta-analyses were performed using random- or fixed-effects models as appropriate. Weighted mean differences (WMDs) or odds ratios (ORs), with their corresponding 95% confidence intervals (CIs), were used for analysis of continuous and dichotomous variables, respectively. Significance level was at p-value less than 0.05.

Results Our initial search yielded 549 unique citations. Eight retrospective cohort (RC) studies (584 patients) were included in the final analysis (339 LH, 245 OH). Overall, major complications (eight RC; n = 584; OR = 0.38; 95% CI: 0.17–0.88; p = 0.02) were more common in OH. When each complication was assessed individually, there were no differences between groups. The length of hospital stay in the LH group was shorter than in the OH group (five RC; n = 418; WMD = − 1.39; 95% CI, −2.56 to −0.22; p = 0.02).

Conclusion Laparoscopic repair for IIH is associated with less major complications and shorter hospital stay, but data are limited due to the absence of randomized controlled trials.

Keywords

incarcerated inguinal hernia - hernia repair - laparoscopy - child - pediatric

Supplementary Material



Publication History

Received: 20 May 2022

Accepted: 11 October 2022

Accepted Manuscript online:
11 October 2022

Article published online:
02 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006; 41 (05) 980-986
    CrossrefPubMedSearch in Google Scholar
  • 2 Niedzielski J, Kr l R, Gawłowska A. Could incarceration of inguinal hernia in children be prevented?. Med Sci Monit 2003; 9 (01) CR16-CR18
    PubMedSearch in Google Scholar
  • 3 Puri P, Guiney EJ, O'Donnell B. Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 1984; 19 (01) 44-46
    CrossrefPubMedSearch in Google Scholar
  • 4 Walc L, Bass J, Rubin S, Walton M. Testicular fate after incarcerated hernia repair and/or orchiopexy performed in patients under 6 months of age. J Pediatr Surg 1995; 30 (08) 1195-1197
    CrossrefPubMedSearch in Google Scholar
  • 5 Wang K, Tan SS, Xiao Y. et al. Characteristics and treatments for pediatric ordinary and incarcerated inguinal hernia based on gender: 12-year experiences from a single center. BMC Surg 2021; 21 (01) 67
    CrossrefPubMedSearch in Google Scholar
  • 6 Chang SJ, Chen JY, Hsu CK, Chuang FC, Yang SS. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia 2016; 20 (04) 559-563
    CrossrefPubMedSearch in Google Scholar
  • 7 Burgmeier C, Dreyhaupt J, Schier F. Comparison of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants. J Pediatr Surg 2014; 49 (09) 1416-1418
    CrossrefPubMedSearch in Google Scholar
  • 8 Houben CH, Chan KW, Mou JW, Tam YH, Lee KH. Irreducible inguinal hernia in children: how serious is it?. J Pediatr Surg 2015; 50 (07) 1174-1176
    CrossrefPubMedSearch in Google Scholar
  • 9 Nah SA, Giacomello L, Eaton S. et al. Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?. Eur J Pediatr Surg 2011; 21 (01) 8-11
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Lee SR. Efficacy of laparoscopic herniorrhaphy for treating incarcerated pediatric inguinal hernia. Hernia 2018; 22 (04) 671-679
    CrossrefPubMedSearch in Google Scholar
  • 11 Ron O, Eaton S, Pierro A. Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children. Br J Surg 2007; 94 (07) 804-811
    CrossrefPubMedSearch in Google Scholar
  • 12 Shalaby R, Shams AM, Mohamed S, el-Leathy M, Ibrahem M, Alsaed G. Two-trocar needlescopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 2007; 42 (07) 1259-1262
    CrossrefPubMedSearch in Google Scholar
  • 13 Mishra PK, Burnand K, Minocha A, Mathur AB, Kulkarni MS, Tsang T. Incarcerated inguinal hernia management in children: ‘a comparison of the open and laparoscopic approach’. Pediatr Surg Int 2014; 30 (06) 621-624
    CrossrefPubMedSearch in Google Scholar
  • 14 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses. Oxford; 2000
    Search in Google Scholar
  • 15 Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13
    CrossrefPubMedSearch in Google Scholar
  • 16 Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 2018; 27 (06) 1785-1805
    CrossrefPubMedSearch in Google Scholar
  • 17 Shi J, Luo D, Weng H. et al. Optimally estimating the sample standard deviation from the five-number summary. Res Synth Methods 2020; 11 (05) 641-654
    CrossrefPubMedSearch in Google Scholar
  • 18 Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135
    CrossrefPubMedSearch in Google Scholar
  • 19 Cumpston M, Li T, Page MJ. et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10: ED000142
    PubMedSearch in Google Scholar
  • 20 Choi SW, Cheung CW. The case of the misleading composite - one outcome is better than two. Anaesthesia 2016; 71 (09) 1101-1103
    CrossrefPubMedSearch in Google Scholar
  • 21 Endo M, Ohno M, Yoshida F. et al. Laparoscopic approach to incarcerated/sliding indirect inguinal hernia in children in comparison with open approach. In: Canonico S. ed. Inguinal Hernia. Rijeka: InTech; 2014: 57
    Search in Google Scholar
  • 22 Jun Z, Juntao G, Shuli L, Li L. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children. J Minim Access Surg 2016; 12 (02) 139-142
    CrossrefPubMedSearch in Google Scholar
  • 23 Koivusalo A, Pakarinen MP, Rintala RJ. Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia. Surg Endosc 2007; 21 (12) 2147-2149
    CrossrefPubMedSearch in Google Scholar
  • 24 Miyano G, Nakamura H, Shibuya S. et al. Scrotal/testicular status after repair of recent severe incarcerated inguinal hernia in male infants younger than 12 months old: Laparoscopic percutaneous extraperitoneal closure versus conventional open repair. Asian J Endosc Surg 2019; 12 (04) 446-448
    CrossrefPubMedSearch in Google Scholar
  • 25 Yin Y, Zhang H, Zhang X. et al. Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children. Exp Ther Med 2016; 12 (06) 3553-3556
    CrossrefPubMedSearch in Google Scholar
  • 26 Balogh B, Hajnal D, Kovács T, Saxena AK. Outcomes of laparoscopic incarcerated inguinal hernia repair in children. J Minim Access Surg 2020; 16 (01) 1-4
    CrossrefPubMedSearch in Google Scholar
  • 27 Chan KW, Lee KH, Tam YH, Sihoe JD, Cheung ST, Mou JW. Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia. J Pediatr Surg 2011; 46 (10) 1970-1973
    CrossrefPubMedSearch in Google Scholar
  • 28 Deeba S, Purkayastha S, Paraskevas P, Athanasiou T, Darzi A, Zacharakis E. Laparoscopic approach to incarcerated and strangulated inguinal hernias. JSLS 2009; 13 (03) 327-331
    PubMedSearch in Google Scholar
  • 29 Kaya M, Hückstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg 2006; 41 (03) 567-569
    CrossrefPubMedSearch in Google Scholar
  • 30 Murase N, Uchida H, Seki T, Hiramatsu K. A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature. Nagoya J Med Sci 2016; 78 (01) 19-25
    PubMedSearch in Google Scholar
  • 31 Zhou X, Peng L, Sha Y, Song D. Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children. J Pediatr Surg 2014; 49 (01) 214-217
    CrossrefPubMedSearch in Google Scholar
  • 32 Turkyilmaz Z, Sonmez K, Karabulut R. et al. Incarcerated inguinal hernia in children. Hong Kong J Emerg Med 2017; 17 (03) 244-249
    CrossrefPubMedSearch in Google Scholar
  • 33 Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg 2006; 41 (06) 1081-1084
    CrossrefPubMedSearch in Google Scholar
  • 34 Shalaby R, Ibrahem R, Shahin M. et al. Laparoscopic hernia repair versus open herniotomy in children: a controlled randomized study. Minim Invasive Surg 2012; 2012: 484135
    PubMedSearch in Google Scholar
  • 35 Dreuning K, Maat S, Twisk J, van Heurn E, Derikx J. Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis. Surg Endosc 2019; 33 (10) 3177-3191
    CrossrefPubMedSearch in Google Scholar