Zhu L L, Xu W J, Liu J B, Huang X, Lv Z B
Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 355, Luding Rd, Shanghai, 200062, China.
Hernia. 2017 Jun;21(3):417-423. doi: 10.1007/s10029-017-1607-x. Epub 2017 Apr 19.
Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic-assisted hernia repair (LH) versus open herniotomy (OH) as regards operative time, postoperative complications, recurrence rate, and contralateral metachronous hernia rate.
We analyzed all the patients with inguinal hernia who underwent surgery in our hospital from January 1, 2015 to December 31, 2015. There were 1125 patients, of which 202 patients received laparoscopic inguinal hernia repair (group A) and 923 patients received open herniotomy (group B). We recalled all the patients' records to identify operative time, postoperative hydrocele formation, and contralateral patent processus vaginalis (CPP) detection; we recalled all the patients' parents to identify the ipsilateral and contralateral recurrence and the testis position.
During the study period, the lost to follow-up rate is 9.9% in group A and 14.1% in group B. The mean follow-up period was about 10.1 months. The mean operative time for females with bilateral hernia in group A was much shorter than that for those in group B (P = 0.001). The postoperative hydrocele formation rate in group A was 1.5%, compared with 8.2% in group B (P = 0.001). The recurrence rate was 0.64% in group A, whereas in group B the recurrence rate was 0.46%. Of patients with unilateral hernia, none in group A experienced a contralateral metachronous hernia (MH) compared with 10.1% in group B (P < 0.001) and 65% MH appeared in 3 months after the first hernia repair. Females and patients with initial left-sided hernia tended to have a contralateral MH after the first open hernia repair.
Laparoscopic hernia repair in children is safe and effective, especially for female patients and patients with initial left-sided hernia. We recommend repairing the CPP simultaneously when performing laparoscopic procedures.
婴幼儿及儿童腹腔镜疝修补术仍存在争议。本研究的目的是比较腹腔镜辅助疝修补术（LH）与开放疝囊高位结扎术（OH）在手术时间、术后并发症、复发率及对侧异时性疝发生率方面的差异。
我们分析了2015年1月1日至2015年12月31日在我院接受手术的所有腹股沟疝患者。共有1125例患者，其中202例接受腹腔镜腹股沟疝修补术（A组），923例接受开放疝囊高位结扎术（B组）。我们查阅了所有患者的病历以确定手术时间、术后鞘膜积液形成情况及对侧鞘状突未闭（CPP）的检出情况；我们联系了所有患者的家长以确定同侧和对侧复发情况及睾丸位置。
研究期间，A组失访率为9.9%，B组为14.1%。平均随访时间约为10.1个月。A组双侧疝女性患者的平均手术时间比B组短得多（P = 0.001）。A组术后鞘膜积液形成率为1.5%，而B组为8.2%（P = 0.001）。A组复发率为0.64%，而B组复发率为0.46%。单侧疝患者中，A组无对侧异时性疝（MH）发生，而B组为10.1%（P < 0.001），65%的MH出现在首次疝修补术后3个月内。女性患者及初始为左侧疝的患者在首次开放疝修补术后更容易出现对侧MH。
儿童腹腔镜疝修补术安全有效，尤其适用于女性患者及初始为左侧疝的患者。我们建议在进行腹腔镜手术时同时修补CPP。
