The Incidence of Recurrence after Laparoscopic Versus Open Inguinal Hernia Repair in Children: a Systematic Review and Meta-Analysis

Abstract

Inguinal surgery is one of the most common surgical procedures in children. However, whether laparoscopic hernia repair is superior to open hernia repair remains unclear. To undertake a systematic review and meta-analysis of randomized controlled trials evaluating the recurrence rate after laparoscopic hernia repair and open hernia repair in children who underwent repair for pediatric inguinal hernia. The Web of Science Database, Pubmed, Embase, WanFang Data, China National Knowledge Infrastructure, and Cochrane Central Register of Controlled Trials were searched to identify eligible studies. The outcomes evaluated were the recurrence rates including metachronous contralateral inguinal hernia and the complication rates associated with both laparoscopic hernia repair and open hernia repair. Seventeen RCTs including 2122 children (2540 hernia defects) were analyzed. Methodologic quality was unclear in most trials. The recurrence rate after inguinal hernia repair in children was 1.3% (33/2540). Meta-analysis of randomized trials did not reveal significant difference between the 2 techniques in the incidence of recurrence (relative risk [OR] = 0.48, 95% confidence interval [CI] = 0.12–1.82, P = 0.280). Simultaneously, there were no significant differences between laparoscopic hernia repair and open hernia repair in the incidence of metachronous contralateral inguinal hernia (OR = 0.33; 95% CI, 0.05–2.30; P = 0.270) and postoperative complications (OR = 0.58; 95% CI, 0.20–1.71; P = 0.320). Laparoscopic repair of a Pediatric hernia does not offer significant advantage over open hernia repair, therefore a decision to perform laparoscopic and/or open repair is best left to the surgeon, expertise available and parents in respective geographic area.