Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
Surg Today. 2019 Dec;49(12):1044-1050. doi: 10.1007/s00595-019-01847-0. Epub 2019 Jul 16.
We compared the outcomes of laparoscopic surgery (LS) with those of open surgery (OS) for unilateral and bilateral pediatric inguinal hernia.
Using a nationwide claim-based database in Japan, we analyzed data from children younger than 15 years old, who underwent inguinal hernia repair between January 2005 and December 2017. Patient characteristics, incidence of reoperation, postoperative complications, length of hospital stay, and duration of anesthesia were compared between LS and OS for unilateral and bilateral hernia.
Among 5554 patients, 2057 underwent LS (unilateral 1095, bilateral 962) and 3497 underwent OS (unilateral 3177, bilateral 320). The incidence of recurrence was not significantly different between OS and LS (unilateral: OS 0.2% vs. LS 0.3%, p = 0.44, bilateral: OS 0.6% vs. LS 0.6%, p = 1.00). The incidence of metachronous hernias was significantly higher in the OS group than in the LS group (4.8% vs. 1.0%, p < 0.001). The surgical site infection rate was significantly lower after OS than after LS for unilateral surgeries (0.9% vs. 2.2%, p = 0.002). There was no difference between OS and LS in the length of hospital stay.
Both OS and LS had a low incidence of recurrence in children; however, the incidence of metachronous hernias was lower for LS, which may influence operative technique decisions.
我们比较了腹腔镜手术（LS）与开放手术（OS）治疗单侧和双侧小儿腹股沟疝的结果。
使用日本全国基于索赔的数据库，我们分析了 2005 年 1 月至 2017 年 12 月期间接受腹股沟疝修补术的年龄小于 15 岁的儿童数据。比较了 LS 和 OS 治疗单侧和双侧疝的患者特征、再次手术发生率、术后并发症、住院时间和麻醉持续时间。
在 5554 例患者中，2057 例接受 LS（单侧 1095 例，双侧 962 例），3497 例接受 OS（单侧 3177 例，双侧 320 例）。OS 和 LS 的复发率无显著差异（单侧：OS 0.2%比 LS 0.3%，p=0.44，双侧：OS 0.6%比 LS 0.6%，p=1.00）。OS 组的同期疝发生率明显高于 LS 组（4.8%比 1.0%，p<0.001）。OS 组单侧手术的手术部位感染率明显低于 LS 组（0.9%比 2.2%，p=0.002）。OS 和 LS 在住院时间方面无差异。
OS 和 LS 在儿童中均具有较低的复发率；然而，LS 的同期疝发生率较低，这可能影响手术技术决策。
