Pediatric Surgery Department, Hippokrateio General Hospital, Thessaloniki, Greece.
General Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Pediatr Surg Int. 2023 Jun 3;39(1):212. doi: 10.1007/s00383-023-05492-0.
This systematic review aims to compare the two major principles of laparoscopic pediatric inguinal hernia repair: totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR), to find out the optimal approach for pediatric patients. A systematic literature search was performed via Pubmed, Embase MEDLINE, and Cochrane databases on all studies published in the last 20 years reporting outcomes on these principles including recurrences, complications, and operative time. Prospective studies for either principle or retrospective comparative studies were considered eligible. Fischer's exact and Student's t test were used for statistical analysis with p value < 0.05 considered statistically significant. Twenty-one studies, including two thousand one hundred and ninety-six patients (LR: 1008), of ages ranging from 9 days to 18 years-old and a male to female ratio of 2.55:1, met our inclusion criteria. Follow-up period varied from 3 months to 8 years. Recurrence rates were similar between the two categories (LR: 1.68% vs. LAR: 1.59%, p > 0.05). As regards post-operative complications, transient hydrocele development was higher in laparoscopic repairs (LAR: 1.01% vs. LR: 3.17% p < 0.005) while wound healing problems were more frequent in laparoscopically assisted repairs (LAR: 1.17% vs. LR: 0.30%, p = 0.019). Mean operative time was lower in laparoscopically assisted repairs both in unilateral (LAR: 21.49 ± 13.51 vs. LR: 29.73 ± 11.05, p = 0.131) and bilateral cases (LAR: 28.01 ± 15.08 vs. LR: 39.48 ± 16.35, p = 0.101) but without statistically significant difference. Both principles are equally effective and safe as their recurrence and overall complications rates are equivalent. Transient hydrocele occurs more often in laparoscopic repairs while wound healing problems are associated mostly with laparoscopically assisted repairs.
完全腹腔镜修补术（LR）和腹腔镜辅助修补术（LAR），以找到小儿患者的最佳治疗方法。通过 Pubmed、Embase MEDLINE 和 Cochrane 数据库系统地检索了过去 20 年中报告这些原则治疗结果的所有研究，包括复发率、并发症和手术时间。纳入了符合条件的任何一种方法的前瞻性研究或回顾性比较研究。Fisher 确切检验和 Student t 检验用于统计分析，p 值<0.05 被认为具有统计学意义。符合纳入标准的研究有 21 项，共 2196 例患者（LR：1008 例），年龄 9 天至 18 岁，男女比例为 2.55:1。随访时间从 3 个月到 8 年不等。两种方法的复发率相似（LR：1.68% vs. LAR：1.59%，p>0.05）。关于术后并发症，腹腔镜修补术后暂时性鞘膜积液发生率较高（LAR：1.01% vs. LR：3.17%，p<0.005），而腹腔镜辅助修补术后伤口愈合问题更为常见（LAR：1.17% vs. LR：0.30%，p=0.019）。单侧手术中，腹腔镜辅助修补术的平均手术时间较低（LAR：21.49±13.51 vs. LR：29.73±11.05，p=0.131），双侧手术中，腹腔镜辅助修补术的平均手术时间也较低（LAR：28.01±15.08 vs. LR：39.48±16.35，p=0.101），但无统计学意义。两种方法均有效且安全，其复发率和总体并发症发生率相当。腹腔镜修补术后更常出现短暂性鞘膜积液，而腹腔镜辅助修补术后更常出现伤口愈合问题。
