Alzahem Abdulrahman
Faculty of Medicine, King Khalid University Hospital, King Saud University, P.O. Box 7805 (37), Riyadh, 11472, Saudi Arabia.
Pediatr Surg Int. 2011 Jun;27(6):605-12. doi: 10.1007/s00383-010-2840-x.
To undertake a meta-analysis of comparative data of laparoscopic versus open inguinal herniotomy in infants and children.
We searched MEDLINE, EMBASE, and The Cochrane Central Controlled Trials Registry for relevant randomized controlled trials and observational studies comparing laparoscopic with open inguinal hernia repair in children aged less than 19 years.
Data on 2,699 children were identified from 10 comparative studies. Laparoscopic techniques were associated with a trend towards higher recurrence rate (OR = 1.81; 95% CI 0.89-3.67; p = 0.10), longer operative time for unilateral repairs (WMD = 10.23; 95% CI 8.82-11.64; p < 0.00001), and may be shorter operative time for bilateral repairs (WMD = -4.54; 95% CI -11.63 to 2.55; p = 0.21). There was a significant reduction in developing a contralateral metachronous inguinal hernia in the laparoscopic group (OR = 0.37; 95% CI 0.20-0.67; p = 0.001).
Laparoscopic inguinal herniotomy is significantly associated with longer operative time for unilateral cases and a reduction in metachronous hernia development. There was a trend towards higher recurrence rate for laparoscopic repairs and shorter operative time for bilateral cases. A well conducted randomized controlled trial is warranted to compare both approaches.
对婴幼儿及儿童腹腔镜与开放腹股沟疝修补术的比较数据进行荟萃分析。
我们检索了MEDLINE、EMBASE和Cochrane中央对照试验注册库，以查找比较19岁以下儿童腹腔镜与开放腹股沟疝修补术的相关随机对照试验和观察性研究。
从10项比较研究中识别出2699名儿童的数据。腹腔镜技术与复发率升高趋势相关（OR = 1.81；95% CI 0.89 - 3.67；p = 0.10），单侧修补手术时间更长（WMD = 10.23；95% CI 8.82 - 11.64；p < 0.00001），双侧修补手术时间可能更短（WMD = -4.54；95% CI -11.63至2.55；p = 0.21）。腹腔镜组对侧迟发性腹股沟疝的发生率显著降低（OR = 0.37；95% CI 0.20 - 0.67；p = 0.001）。
腹腔镜腹股沟疝修补术与单侧病例手术时间延长及迟发性疝发生率降低显著相关。腹腔镜修补术有复发率升高趋势，双侧病例手术时间缩短。有必要进行一项精心设计的随机对照试验来比较这两种方法。
