Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Room B04.2028, Montréal, QC H4A 3J1, Canada.
Division of Pediatric Surgery, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
J Pediatr Surg. 2023 Jan;58(1):146-152. doi: 10.1016/j.jpedsurg.2022.09.023. Epub 2022 Oct 6.
The optimal approach for pediatric inguinal hernia repair continues to be debated. We conducted a regional retrospective study to assess rates of recurrence and metachronous hernias after open repair (OPEN) and laparoscopic repair (LAP) METHODS: A retrospective cohort study was conducted at two children's hospitals that serve a region of approximately 4 million people. All patients < 14 years old undergoing OPEN or LAP by pediatric surgeons during a 5-year period (2011 - 2015) were analyzed after a minimum follow up of 4 years. Cox proportional regression was used to compare the effect of surgical approach on hernia recurrence and metachronous contralateral hernias.
A total of 1,952 patients, 587 female (30%) and 1365 male (70%), had 2305 hernias repaired. Median post operative follow up time was 6.6 years (range 4-9 years). OPEN and LAP were performed for 1827 (79%) and 478 (21%) hernias, respectively. There were no significant differences in rate of prematurity, age at repair, or frequency of emergent repair. LAP was associated with a lower incidence of metachronous contralateral hernias compared to OPEN (1.4% vs 3.8%, p = 0.047), and a higher incidence of recurrence (9% vs 0.9%, p < 0.001). After adjusting for confounders, LAP had a higher rate of recurrence than OPEN (hazard ratio 10.4, 95% CI 6-18.1).The recurrence rate did not decrease over the study period (p = 0.731).
Laparoscopic inguinal hernia repair in children resulted in a modest decrease in the incidence of metachronous hernias, at the cost of a significant increase in recurrence.
Retrospective Comparative Study.
Level III.
小儿腹股沟疝修补术的最佳方法仍存在争议。我们进行了一项区域性回顾性研究，以评估开放修补术（OPEN）和腹腔镜修补术（LAP）后的复发率和同期对侧疝。
对两家儿童医院的回顾性队列研究，这两家医院服务于一个约 400 万人的地区。所有接受小儿外科医生在 5 年期间（2011 年至 2015 年）进行 OPEN 或 LAP 的患者，在至少 4 年的随访后进行分析。Cox 比例风险回归用于比较手术方法对疝复发和同期对侧疝的影响。
共有 1952 名患者，587 名女性（30%）和 1365 名男性（70%），有 2305 例疝需要修补。中位术后随访时间为 6.6 年（4-9 年）。OPEN 和 LAP 分别用于 1827 例（79%）和 478 例（21%）疝。早产儿、手术年龄或急诊修复的频率没有显著差异。与 OPEN 相比，LAP 同期对侧疝的发生率较低（1.4%比 3.8%，p=0.047），复发率较高（9%比 0.9%，p<0.001）。调整混杂因素后，LAP 的复发率高于 OPEN（风险比 10.4，95%置信区间 6-18.1）。在研究期间，复发率并没有下降（p=0.731）。
腹腔镜小儿腹股沟疝修补术导致同期疝的发生率略有下降，但复发率显著增加。
回顾性比较研究。
三级。
