Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, Instituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Eur J Pediatr Surg. 2022 Jun;32(3):219-232. doi: 10.1055/s-0040-1721420. Epub 2021 Feb 10.
Inguinal hernia repair represents the most common operation in childhood; however, consensus about the optimal management is lacking. Hence, recommendations for clinical practice are needed. This study assesses the available evidence and compiles recommendations on pediatric inguinal hernia.
The European Pediatric Surgeons' Association Evidence and Guideline Committee addressed six questions on pediatric inguinal hernia repair with the following topics: (1) open versus laparoscopic repair, (2) extraperitoneal versus transperitoneal repair, (3) contralateral exploration, (4) surgical timing, (5) anesthesia technique in preterm infants, and (6) operation urgency in girls with irreducible ovarian hernia. Systematic literature searches were performed using PubMed, MEDLINE, Embase (Ovid), and The Cochrane Library. Reviews and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.
Seventy-two out of 5,173 articles were included, 27 in the meta-analyses. Laparoscopic repair shortens bilateral operation time compared with open repair. In preterm infants, hernia repair after neonatal intensive care unit (NICU)/hospital discharge is associated with less respiratory difficulties and recurrences, regional anesthesia is associated with a decrease of postoperative apnea and pain. The review regarding operation urgency for irreducible ovarian hernia gained insufficient evidence of low quality.
Laparoscopic repair may be beneficial for children with bilateral hernia and preterm infants may benefit using regional anesthesia and postponing surgery. However, no definite superiority was found and available evidence was of moderate-to-low quality. Evidence for other topics was less conclusive. For the optimal management of inguinal hernia repair, a tailored approach is recommended taking into account the local facilities, resources, and expertise of the medical team involved.
腹股沟疝修补术是儿童最常见的手术，但对于最佳治疗方法尚未达成共识。因此，需要制定临床实践建议。本研究评估了现有证据，并就小儿腹股沟疝的治疗提出了建议。
欧洲小儿外科医师协会证据和指南委员会针对小儿腹股沟疝修补术的 6 个问题进行了研究，包括：（1）开放式与腹腔镜式修复；（2）腹膜外与经腹腔修复；（3）对侧探查；（4）手术时机；（5）早产儿麻醉技术；（6）不可复性卵巢疝女孩手术的紧迫性。使用 PubMed、MEDLINE、Embase（Ovid）和 The Cochrane Library 进行系统文献检索。根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行综述和荟萃分析。
从 5173 篇文章中筛选出 72 篇，其中 27 篇进行了荟萃分析。与开放式修复相比，腹腔镜修复可缩短双侧手术时间。对于早产儿，在新生儿重症监护病房（NICU）/出院后进行疝修补术与减少呼吸问题和复发有关，区域麻醉与术后呼吸暂停和疼痛减少有关。对于不可复性卵巢疝手术紧迫性的综述获得了低质量的证据。
腹腔镜修复可能对双侧疝患儿有益，对于早产儿，区域麻醉和推迟手术可能有益。然而，没有明确的优势，且现有证据的质量为中低质量。其他主题的证据不太具有结论性。对于腹股沟疝修补术的最佳管理，建议采用个体化方法，考虑到当地的设施、资源和医疗团队的专业知识。
