Carter Michela, Papastefan Steven T, Tian Yao, Hartman Stephen J, Elman Meredith S, Ungerleider Sara G, Garrison Aaron P, Oyetunji Tolulope A, Landman Matthew P, Raval Mehul V, Goldstein Seth D, Lautz Timothy B
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Northwestern Quality Improvement, Research and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
J Pediatr Surg. 2025 Feb;60(2):162056. doi: 10.1016/j.jpedsurg.2024.162056. Epub 2024 Nov 7.
Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.
This retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates.
We identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p = 0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p < 0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS.
Laparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia.
Treatment Study - Level III.
在过去十年中，腹腔镜腹股沟疝修补术的应用显著增加。本研究的目的是比较在一个大型全国队列中，开放手术和腹腔镜腹股沟疝修补术后二次疝手术率及同侧复发率。
这项回顾性分析利用儿科健康信息系统数据库，识别2017年至2021年期间接受腹腔镜或开放原发性腹股沟疝修补术的18岁以下儿童。收集数据至2022年，以确保至少一年的随访。通过多变量混合效应模型比较二次疝手术率（包括同侧复发和异时性对侧疝）及同侧复发率，该模型控制了混杂因素和机构聚类。通过对四个成员机构的数据验证确定错误分类率。敏感性分析确定真实结局率。
我们识别出53287例手术（15.6%为腹腔镜手术）。腹腔镜修补术后二次疝手术率更高（2.9%对2.6%，p = 0.04），但多变量分析无差异（OR 1.14，95%CI 0.98 - 1.32）。腹腔镜修补术后同侧复发率更高（1.5%对0.4%，p < 0.001），多变量分析中该差异仍然存在（OR 3.72，95%CI 2.90 - 4.78）。敏感性分析显示腹腔镜和开放修补的真实率分别为14.2%和85.8%。二次疝手术和同侧复发的真实率与PHIS确定的一致。
儿童腹腔镜腹股沟疝修补术同侧疝复发几率是开放修补术的三倍多，而异时性疝二次手术率降低可对此进行平衡。
治疗研究 - 三级。
