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Goneidy A, Verhoef C, Lansdale N, Peters RT, Wilkinson DJ. Laparoscopic hernia repair in children: does recreating the open operation improve outcomes? A systematic review. Hernia 2023; 27:1037-1046. [PMID: 36949270 PMCID: PMC10533621 DOI: 10.1007/s10029-023-02772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The use of laparoscopy for paediatric inguinal hernia repairs has increased significantly over the past 2 decades. However, there is significant variation in the reported recurrence rates in the literature, with many studies reporting higher rates than the open operation. This may be explained by the range of different techniques currently included under the term laparoscopic inguinal hernia repair. The purpose of this study is to determine whether dividing the hernia sac before ligation improves surgical outcomes following a paediatric laparoscopic inguinal hernia repair compared to ligation alone. METHODS A systematic review of the literature was performed following PRISMA guidelines of all studies reporting the outcomes following paediatric laparoscopic inguinal hernia repair where the technique was recorded as laparoscopic suture ligation alone (LS) or laparoscopic sac division and suture ligation (LSDS). Studies were assessed for risk of bias and exclusion criteria included reported follow-up of less than 6 months. RESULTS A total of 8518 LS repairs and 6272 LSDS repairs were included in the final analysis. LSDS repair was associated with a significantly lower recurrence rate (odds ratio 0.51, 95% CI 0.36-0.71, p = 0.001). There was no significant difference in the rates of testicular ascent or atrophy. CONCLUSION Recreating the open operation by hernia sac division followed by suture ligation significantly reduces the risk of hernia recurrence.
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Affiliation(s)
- Ayman Goneidy
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Christian Verhoef
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Nick Lansdale
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Robert T Peters
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - David J Wilkinson
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
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Luo Z, Cao Z, Wang K, Li S, Cao G, Chi S, Zhang X, Li K, Zhou Y, Guo J, Tian M, Tang S. Re-evaluation of jumping purse-string suturing in pediatric laparoscopic hernia repair. Surg Endosc 2021; 36:3277-3284. [PMID: 34327548 DOI: 10.1007/s00464-021-08640-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reported recurrence rates using jumping purse-string suturing in laparoscopic hernia repair (LH) are higher than that of intact purse-string. This study aims to compare the outcomes of LH using transabdominal jumping purse-string suturing (TJS) with those using transabdominal intact purse-string suturing (TIS) and percutaneous extraperitoneal intact purse-string suturing (PEIS). METHODS A total of 3340 patients from three centers who have undergone laparoscopic hernia repair from January 2016 to June 2019 were retrospectively reviewed. Of these, 1460 patients received TJS, 724 patients received TIS, and 1006 patients received PEIS. One hundred and fifty patients were excluded due to the loss of follow-up. Demographic characteristics, intraoperative findings, and postoperative complications were analyzed. RESULTS The hernia distribution characteristics and mean length of hospital stay were similar among the three groups (p > 0.05, p > 0.05). While the overall complication rates were similar among the three groups (0.34% in TJS vs. 0.41% in TIS vs. 0.50% in PEIS, TJS & TIS p = 0.502; TJS & PEIS p = 0.813), the incidence of intraoperative hematoma in TIS group and postoperative subcutaneous knot in PEIS group was significantly higher ((0.83% in TIS and 0.34% in TJS vs. 0.2% in PEIS, TJS & TIS p = 0.018; TJS & PEIS p = 0.163), (0% in TIS and 0% in TJS vs. 0.2% in PEIS, TJS & TIS p = 0.415; TJS & PEIS p = 0.025)). There were no differences in the recurrent rate in both unilateral and bilateral cases. CONCLUSIONS Transabdominal jumping purse-string suturing is not associated with a higher recurrence rate and is the recommended surgical approach.
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Affiliation(s)
- Zhibin Luo
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqing Cao
- Department of Pediatric Surgery, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong Province, China
| | - Kangtai Wang
- Department of Pediatric Surgery, Hubei Enshi Autonomous Prefecture Central Hospital, Enshi City, Hubei Province, China
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuiqing Chi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Zhou
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jialing Guo
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Tian
- Department of Hernia and Abdominal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Shaotao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Wang F, Zhong H, Shou T, Chen Y, Zhao J. Single-Site Laparoscopic Percutaneous Extraperitoneal Closure Versus Modified Transumbilical Two-Port Laparoscopic Suturing of the Hernia Sac for the Treatment of Pediatric Inguinal Hernia: Comparison of the Outcomes of Two Different Approaches. J Laparoendosc Adv Surg Tech A 2018; 29:103-108. [PMID: 30222529 DOI: 10.1089/lap.2018.0405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the surgical outcomes of single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) and modified transumbilical two-port laparoscopic suturing (M-TTLS) of the hernia sac for the treatment of pediatric inguinal hernia (PIH) and determine whether one approach was superior to another. METHODS From January 2014 to June 2017, a total of 599 children had undergone SLPEC or M-TTLS in our department. SLPEC and M-TTLS were the most frequently performed single-site laparoscopic procedures for PIH in our department, which represented the extraperitoneal and intraperitoneal approaches, respectively. All patients were followed up at the out-patients' clinics and the medical records were reviewed with respect to all operative outcomes. RESULTS There were 412 patients undergoing SLPEC and 187 patients undergoing M-TTLS, of which 358 hernias were on the right side, 172 on the left and 69 bilaterally. Two hundred and thirty-one unilateral hernias with contralateral patent processus vaginalis underwent contralateral repair at the same session. Mean operation time was 10.81 minutes in unilateral repair and 17.00 minutes in bilateral repairs, respectively. The perioperative complications included minor extraperitoneal hematoma in four (0.44%) patients, recurrence in one (0.11%), hydrocele in five (0.56%), and contralateral metachronous inguinal hernia in three (1.00%). No other complication developed in either group. There was no significant difference of complications between the two approaches except for the longer operation time in M-TTLS. CONCLUSIONS Both SLPEC and M-TTLS were the safe and effective methods for PIH. The complications were comparable for M-TTLS and SLPEC, but operation time was significantly longer in M-TTLS than in SLPEC.
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Affiliation(s)
- Furan Wang
- 1 Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - Hongji Zhong
- 2 Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Tiejun Shou
- 1 Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - Yi Chen
- 2 Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Junfeng Zhao
- 1 Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
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