Department of Medical Education, Taipei Medical University Hospital, Taipei City, Taiwan.
Division of Pediatric Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan.
J Pediatr Surg. 2023 Jul;58(7):1322-1331. doi: 10.1016/j.jpedsurg.2023.01.054. Epub 2023 Feb 14.
Pediatric inguinal hernia is a common surgical problem in boys. Open hernia repair surgery (OH) has been traditionally used to treat this condition, but it leads to complications, such as testicular complications. Laparoscopic hernia repair by using the extraperitoneal method (LHE) is performed through the percutaneous insertion of sutures and extracorporeal closure of patent vaginalis processus; thus, injury to spermatic cord structures is avoided. However, a meta-analysis comparing LHE and OH is lacking.
PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. A meta-analysis of the retrieved studies was performed, and a random-effects model was used to calculate the pooled effect size. The primary outcome was testicular complications, including ascending testis, hydrocele, and testicular atrophy. The secondary outcomes were surgical metachronous contralateral inguinal hernia (MCIH), ipsilateral hernia recurrence, and operation time.
In total, 6 randomized controlled trials (RCTs) and 20 non-RCTs involving 17,555 boys were included. The incidence of ascending testis (risk ratio [RR]: 0.38, 95% confidence interval [CI]: 0.18-0.78; p = 0.008) and MCIH (RR: 0.17, 95% CI: 0.07-0.43; p = 0.0002) was significantly lower in LHE than in OH. The incidence of hydrocele, testicular atrophy, and ipsilateral hernia recurrence did not differ between LHE and OH.
Compared with OH, LHE led to fewer or equivalent testicular complications without increasing ipsilateral hernia recurrence. Moreover, MCIH incidence was lower in LHE than in OH. Hence, LHE could be a feasible choice with less invasiveness for inguinal hernia repair in boys.
Treatment study, LEVEL III.
小儿腹股沟疝是男孩中常见的外科问题。传统上，开放疝修补术（OH）用于治疗这种疾病，但会导致并发症，如睾丸并发症。经皮插入缝线和体外闭合未闭的鞘突法（LHE）的腹腔镜疝修补术可避免精索结构损伤。然而，缺乏比较 LHE 和 OH 的荟萃分析。
检索 PubMed、EMBASE 和 Cochrane 图书馆数据库中的相关研究。对检索到的研究进行荟萃分析，并使用随机效应模型计算汇总效应量。主要结局是睾丸并发症，包括睾丸上移、鞘膜积液和睾丸萎缩。次要结局是手术性对侧腹股沟疝（MCIH）、同侧疝复发和手术时间。
共纳入 6 项随机对照试验（RCT）和 20 项非 RCT，涉及 17555 名男孩。LHE 组睾丸上移（风险比 [RR]：0.38，95%置信区间 [CI]：0.18-0.78；p=0.008）和 MCIH（RR：0.17，95% CI：0.07-0.43；p=0.0002）的发生率明显低于 OH 组。LHE 组和 OH 组的鞘膜积液、睾丸萎缩和同侧疝复发的发生率无差异。
与 OH 相比，LHE 导致睾丸并发症的发生率较低或相当，而不会增加同侧疝复发的风险。此外，LHE 组 MCIH 的发生率低于 OH 组。因此，LHE 可能是一种可行的选择，具有较低的侵入性，用于治疗男孩的腹股沟疝。
治疗研究，III 级。
