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Peace AE, Duchesneau ED, Agala CB, Phillips MR, McLean SE, Hayes AA, Akinkuotu AC. Costs and recurrence of inguinal hernia repair in premature infants during neonatal admission. J Pediatr Surg 2023; 58:445-452. [PMID: 36529566 PMCID: PMC10243490 DOI: 10.1016/j.jpedsurg.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Timing of inguinal hernia repair (IHR) in premature infants remains variable, yet the impact of IHR timing on procedure costs and recurrence is unclear. We sought to compare cost and recurrence rates of IHR in premature infants based on timing of repair. METHODS We performed a retrospective cohort study using MarketScan insurance claims data from 2007 to 2018 to evaluate IHR occurring within 365 days of birth in preterm infants (gestational age [GA]<37 weeks at birth). Patients were stratified based on timing of IHR: those occurring during and after neonatal discharge. Hernia recurrences within one year following IHR were identified. Patient demographic characteristics and costs were compared between groups. Time to recurrence and cumulative recurrence hazards were estimated using Kaplan Meier analysis and Cox proportional hazards regression. RESULTS We identified 3,662 preterm infants with IHR within 365 days of birth; 1,054(28.8%) occurred early. Infants with IHR during NICU stay were more likely to have GA at birth≤32 weeks (74.7% vs. 37.2%; p<0.01) and birthweight<1500 g (83.0% vs. 40.3%; p<0.01) compared to post-NICU IHR. The hernia recurrence rate was higher and total procedure costs lower in early IHR. Early IHR (HR:1.86, 95% CI: 1.56-2.22), incarcerated/strangulated hernia (HR:1.86, 95% CI:1.49-2.32), GA≤32 weeks (HR: 1.40, 95% CI: 1.19-1.65), and congenital anomalies (HR: 1.32, 95% CI: 1.12-1.57) were predictors of hernia recurrence. CONCLUSION Using insurance claims data, IHR performed during initial neonatal admission was associated with lower cost, but higher recurrence rate, when compared to delayed repairs in preterm infants. TYPE OF STUDY Retrospective study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Alyssa E Peace
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Emilie D Duchesneau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill NC, United States
| | - Chris B Agala
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Andrea A Hayes
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, United States.
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Diagnostic Accuracy of Imaging Modalities on Occult Groin Hernias According to Hernia type and a Surgeon-centered Individualized Groin Hernia Management Algorithm. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2023; 33:79-83. [PMID: 36728685 DOI: 10.1097/sle.0000000000001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate the diagnostic performance of imaging techniques for the identification of groin hernias based on the type of hernia and to demonstrate the efficacy of an algorithm based on the surgeon and surgical technique. MATERIALS AND METHODS Medical records of 561 patients who were operated on for groin hernia were retrospectively analyzed. A total of 102 patients who had both pelvic computed tomography (CT) and ultrasonography (USG) recordings preoperatively and underwent transabdominal preperitoneal repair were included in the study. RESULTS A contralateral asymptomatic occult groin hernia was detected in 25.5% of all patients. The overall sensitivity of USG and CT on contralateral asymptomatic occult hernia was 42.3% and 65.4%, respectively. The sensitivity of USG according to the contralateral occult hernia type was 66.7%, 35.7%, 33.3%, and 50% for direct, indirect, femoral, and pantaloon hernias, respectively. The sensitivity of CT according to the contralateral occult hernia type was 0%, 57.1%, 100%, and 100% for direct, indirect, femoral, and pantaloon hernias, respectively. CONCLUSIONS The handicap created by the variability in the diagnostic sensitivity of imaging modalities can be overcome with the choice of transabdominal preperitoneal repair in the surgical technique.
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Lam CS, Dhedli PK, Russell S, Stedman FE, Hall NJ. Cost-Effectiveness of Laparoscopic and Open Pediatric Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2022; 32:805-810. [PMID: 35483082 DOI: 10.1089/lap.2021.0800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: Laparoscopic inguinal hernia (IH) repair is an alternative to open surgery. A potential advantage of laparoscopic repair is prevention of contralateral metachronous hernia although some studies report higher recurrence rate. We aim to determine the cost-effectiveness of open versus laparoscopic IH repair taking into account metachronous and recurrence rates. Methods: Retrospective single-center study of children (<5 years) undergoing elective open or laparoscopic repair for a unilateral IH between February 2018 and October 2019. Ten cases in each of four groups were included (open day case, open overnight, laparoscopic day case, and laparoscopic overnight). Cases incurring a higher cost due to comorbidities or additional procedure were excluded. Patient-level information and costing system data were obtained from the hospital finance. Mean (standard deviation [SD]) procedural cost was compared for open and laparoscopic procedures. A financial model was created factoring metachronous and recurrent rates. Results: Cost of open day case repair was £1866.24 (SD: 311.15) compared with £2210.13 (SD: 391.36) for day case laparoscopic repair. For overnight repair, cost of open was £2442.82 (SD: 497.05) compared with £2585.35 (SD: 384.66) for laparoscopic. On calculating the cost-effectiveness point using the difference in metachronous and recurrence rate between the two procedures, laparoscopic is more cost-effective than open day case repair at 18.43%. For overnight repair, the difference rate is 5.84%. Conclusion: Our data suggest that based on metachronous and recurrence rates in the current literature, laparoscopic IH repair is more cost-effective than open repair for cases requiring overnight stay, whereas for day case procedures open IH repair is more cost-effective.
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Affiliation(s)
- Christine S Lam
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Pavleen K Dhedli
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Samantha Russell
- Finance Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Francesca E Stedman
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.,University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Shaughnessy MP, Maassel NL, Yung N, Solomon DG, Cowles RA. Laparoscopy is increasingly used for pediatric inguinal hernia repair. J Pediatr Surg 2021; 56:2016-2021. [PMID: 33549307 DOI: 10.1016/j.jpedsurg.2021.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Inguinal hernia repairs (IHR) are commonly performed by pediatric surgeons in the United States. The operative approach depends on surgeon preference with no definitive prospective studies comparing laparoscopic inguinal hernia repair (LIHR) versus traditional inguinal hernia repair (TIHR). We aim to assess current practice, hypothesizing that laparoscopy is increasingly used for pediatric IHR. MATERIAL & METHODS The Children's Hospital Association (CHA) Pediatric Health Information System was queried for IHRs performed between 01/01/2009 and 12/31/2018. Demographics, procedure type, hernia laterality, and cost were obtained. Patients were grouped by procedure type (laparoscopic/traditional). RESULTS 125,249 IHRs were performed at 32 CHA hospitals during the ten-year study period. 115,782 (92.4%) were TIHR and 9467 (7.6%) LIHR. Use of laparoscopy increased 5-fold from 3% to 15% over the study period. When comparing laparoscopic to traditional IHR groups, there were more females (28.3% vs 12.6%), African-Americans (19.7% vs 14.4%), government-insured (50% vs 45.2%), younger patients (4.2 vs 4.4 years), bilateral IHRs (11.4% vs 7.9%), and higher adjusted total hospital cost ($3,791 vs $2995) in the laparoscopic group (p<0.0001, all comparisons). CONCLUSIONS Laparoscopy for pediatric IHR is increasing at CHA hospitals where nearly 1 in 6 children currently undergoes a laparoscopic repair. The long-term outcomes with laparoscopic repair are worthy of future study.
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Affiliation(s)
- Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nathan L Maassel
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nicholas Yung
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Daniel G Solomon
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States.
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Zakaria OM. Patent Contralateral Processus Vaginalis in Infants and Children: Is Herniotomy Justified? Oman Med J 2018; 33:481-485. [PMID: 30410690 DOI: 10.5001/omj.2018.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Contralateral inguinal exploration in pediatric unilateral inguinal hernia has been an issue of debate. Controversy still exists on whether contralateral patent processus vaginalis (CPPV) is justifiable for herniotomy. This study was conducted to investigate the hypothesis that CPPV always necessitates herniotomy. Methods This prospective study was conducted on 200 pediatric patients aged 2-120 months old. All patients clinically diagnosed with a unilateral inguinal hernia underwent a clinical examination of both inguinoscrotal regions followed by ultrasonography to elucidate CPPV in both sides. Herniotomy was then performed on the hernia site with laparoscopic evaluation of CPPV. Contralateral herniotomy was performed in 44 patients with Chin's type III CPPV while the rest were followed-up for three years to detect the appearance of any contralateral inguinal hernia. Results The current study included 158 boys and 42 girls (ratio of 3.8:1.0). Hernia was more common on the right side (n = 136) than the left side (n = 64). Bilateral herniotomy was performed on 44 patients with Chin's type III CPPV, while the remaining 156 patients underwent unilateral herniotomy. During the follow-up period, contralateral hernia appeared in 58 patients; the remaining 98 patients, proved to have CPPV did not complain of a clinical hernia during that period. Conclusions Inguinal herniotomy for CPPV seems not to be necessary in all cases. This would decrease the use of anesthesia and surgical morbidity in young infants and save hospital resources through avoidance of
unnecessary operations.
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Affiliation(s)
- Ossama M Zakaria
- Department of Surgery, Division of Pediatric Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Abstract
Laparoscopy is a safe and effective technique in the repair of inguinal hernias. This article describes the different laparoscopic herniorrhaphy technique, as well as controversial topics, such as premature infants, contralateral repair, and incarcerated hernias.
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Affiliation(s)
- Sophia Abdulhai
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA
| | - Ian C Glenn
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA
| | - Todd A Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA.
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8
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Pandey R, Dako J, Venus S, Kumar D, Mhanna M. Early versus late inguinal hernia repair in extremely low-birthweight infants. J Matern Fetal Neonatal Med 2016; 30:2457-2460. [DOI: 10.1080/14767058.2016.1253059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rajesh Pandey
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA,
- Department of Pediatrics, Division of Neonatal- Perinatal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA and
| | - Joleen Dako
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA,
| | - Sarah Venus
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Deepak Kumar
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA,
| | - Maroun Mhanna
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA,
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9
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Zhao J, Chen Y, Lin J, Jin Y, Yang H, Wang F, Zhong H, Zhu J. Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia. Br J Surg 2016; 104:148-151. [PMID: 27778329 DOI: 10.1002/bjs.10302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/21/2016] [Accepted: 07/25/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV. METHODS Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH. The presence of CPPV was evaluated during laparoscopy and, if detected, the CPPV was closed. The relationship between CPPV and subsequent MIH was studied. RESULTS The study included children who had complete follow-up (90·0 per cent of those having open repair and 92·2 per cent of those undergoing laparoscopic repair). Of 2538 children who had open hernia repair, 62 (2·4 per cent) developed MIH (30 on the right side and 32 on the left; P = 0·015). Among 2855 children who underwent laparoscopic repair, a CPPV was identified and closed in 1469 (51·5 per cent). The rate of MIH after negative laparoscopic evaluation for CPPV was three of 2855 (0·1 per cent). There were no significant differences in the rate of CPPV between sexes and either the right or left side (P = 0·072 and P = 0·099 respectively). Ipsilateral recurrence was less frequent after laparoscopic repair: seven (0·2 per cent) versus 26 (1·0 per cent) for open repair (P < 0·001). CONCLUSION Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH.
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Affiliation(s)
- J Zhao
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - Y Chen
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - J Lin
- Department of Paediatric Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Jin
- Department of Child Healthcare, Gulin Institute of Health, Ningbo, Zhejiang, China
| | - H Yang
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - F Wang
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - H Zhong
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - J Zhu
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
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Xu Q, Liu SQ, Niu JH, Luo RX, Zhang J, Zhang PF, Li XL, Peng F. RETRACTED: A new technique for extraperitoneal repair of inguinal hernia. J Surg Res 2016; 204:452-459. [PMID: 27565082 DOI: 10.1016/j.jss.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/07/2016] [Accepted: 05/03/2016] [Indexed: 12/21/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
This article has been retracted at the request of the Editor-in-Chief and authors, as portions of the clinical data used were inaccurate. Specifically, more than 500 cases of the total 1882 cases of hernia patients presented in the paper were actually hydrocele of tunica vaginalis, not hernia. The authors sincerely apologize for these errors.
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Affiliation(s)
- Quan Xu
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China
| | - Shi-Qi Liu
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China.
| | - Jian-Hua Niu
- Third Department of General Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shi He Zi, Xinjiang province, China
| | - Rui-Xue Luo
- Northwest Institute for Nonferrous Metal Research (NIN), Xi'an, Shanxi Province, China
| | - Jing Zhang
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China
| | - Peng-Fei Zhang
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China
| | - Xiao-Long Li
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China
| | - Fei Peng
- Department of Pediatric Surgery, The Northwest Women's and Children's Hospital, Xi'an, Shanxi Province, China
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Ahmed H, Youssef MK, Salem EA, Fawzi AM, Desoky EAE, Eliwa AM, Sakr AMN, Shahin AMS. Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children. J Pediatr Urol 2016; 12:50.e1-5. [PMID: 26421498 DOI: 10.1016/j.jpurol.2015.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic hernia repairs have been proven to be efficient and safe for children, despite the slightly higher recurrence rate compared with the classic surgical repair. They have the advantage of easy and precise identification of the type of defect and its correction, both in ipsilateral and contralateral sides. OBJECTIVES The objectives of this study were to evaluate the efficacy, safety and outcome of the laparoscopically assisted piecemeal high ligation of a patent processus vaginalis (PPV) in children. METHODS A total of 40 children were enrolled into this prospective study; they were aged ≥ 6 months and had an inguinal hernia. The peritoneal cavity, including the contralateral side, was inspected for the possibility of bilateral hernias using a 3-mm 30° telescope. Another 3-mm port was introduced through the same infra-umbilical incision. The hernia was manually reduced or with the aid of a working infra-umbilical grasper. A prolene or vicryl 2/0 or 3/0 suture on a curved semicircle round-bodied taper-ended 25-30 mm needle was introduced through a very small inguinal skin-crease incision. It was passed through the abdominal wall layers to the peritoneum and was manipulated by the laparoscopic grasper to pick up the peritoneum in piecemeal all around the internal ring. The needle was then pushed to the outside near to the entrance site, thus forming a semicircle around the internal ring. The suture was then tied and the knot was subcutaneously buried. The primary outcome of the procedure was the incidence of intraoperative diagnosis and surgical repair of contralateral hernias in pre-operatively diagnosed unilateral cases. The secondary outcomes were defined as the incidence of complications and hernia recurrence. DISCUSSION The exploratory laparoscopy found contralateral patent processus vaginalis (CPPV) with a detection rate of 28.1%. Chan et al., Esposito et al., Toufique et al. and Niyogi et al. reported similar figures for laparoscopic contralateral hernia detection rates of 28%, 39%, 39.7% and 29.2%, respectively. The limitations of this study were the small sample size, plus the risk factors and clinical significance for CPPV. CONCLUSION Laparascopically assisted piecemeal closure of the internal inguinal ring in children is a safe and effective procedure. It helps in detecting a contralateral hernia without prolonging the operative time.
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Affiliation(s)
- H Ahmed
- Benha University, Faculty of Medicine, Dept. of General Surgery, Egypt.
| | - M K Youssef
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - E A Salem
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M Fawzi
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - E A E Desoky
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M Eliwa
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M N Sakr
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
| | - A M S Shahin
- Zagazig University, Faculty of Medicine, Dept. of Urology, Zagazig, Egypt.
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Abstract
The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.
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Affiliation(s)
- Himanshu Aggarwal
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| | - Barry A Kogan
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
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13
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Fotso Kamdem A, Nerich V, Auber F, Jantchou P, Ecarnot F, Woronoff-Lemsi MC. Quality assessment of economic evaluation studies in pediatric surgery: a systematic review. J Pediatr Surg 2015; 50:659-87. [PMID: 25840083 DOI: 10.1016/j.jpedsurg.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess economic evaluation studies (EES) in pediatric surgery and to identify potential factors associated with high-quality studies. METHODS A systematic review of the literature using PubMed and Cochrane databases was conducted to identify EES in pediatric surgery published between 1 June 1993 and 30 June 2013. Assessment criteria are derived from the Drummond checklist. A high quality study was defined as a Drummond score ≥7. Logistic regression analysis was used to determine factors associated with high quality studies. RESULTS 119 studies were included. 43.7% (n=52) of studies were full EES. Cost-effectiveness analysis was the most frequent (61.5%) type of full EES. Only 31.6% of studies had a Drummond score ≥7 and 73% of these were full EES. The factors associated with high quality were identification of costs (OR: 14.08; 95% CI: 3.38-100; p<0.001), estimation of utility value (OR: 8.13; 95% CI: 2.02-43.47; p=0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p=0.02). CONCLUSION This review shows that the number and the quality of EES are low despite the increasing number of studies published in recent years. In the current context of budget constraints, our results should encourage pediatric surgeons to focus more on EES.
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Affiliation(s)
- Arnaud Fotso Kamdem
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Virginie Nerich
- INSERM U645 EA-2284 IFR-133, Department of Pharmacy, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Frederic Auber
- UMR-INSERM-1098, Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besancon, France.
| | - Prévost Jantchou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Sainte-Justine University Hospital, 3175, Chemin de la Côte Sainte-Catherine, H3T 1C5, Montréal, Quebec, Canada.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, Besançon University Hospital, 3 Boulevard Fleming, F-25000 Besançon, France.
| | - Marie-Christine Woronoff-Lemsi
- UMR-INSERM-1098, Department of Clinical Research and Innovation, Besançon University Hospital, 2 place Saint Jacques, F-25000 Besançon, France.
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Lee DG, Lee YS, Park KH, Baek M. Risk factors for contralateral patent processus vaginalis determined by transinguinal laparoscopic examination. Exp Ther Med 2015; 9:421-424. [PMID: 25574209 PMCID: PMC4280956 DOI: 10.3892/etm.2014.2098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022] Open
Abstract
Concurrent contralateral inguinal exploration in children with unilateral hernia or hydrocele is a subject of debate. The aim of the present study was to investigate the incidence of contralateral patent processus vaginalis (CPPV) using transinguinal laparoscopy (inguinoscopy). In addition, the risk factors of CPPV were evaluated in order to facilitate the selection of appropriate candidates for contralateral examination. A total of 119 patients who presented with unilateral hydrocele, inguinal hernia or cryptorchidism between 2001 and 2008 underwent inguinoscopy during the ipsilateral surgery. All data were collected prospectively. The incidence of CPPV was investigated and the risk factors affecting the presence of CPPV were analyzed. Among these patients, 29 individuals (24.4%) had CPPV confirmed by inguinoscopy. No surgical complications were observed during the inguinoscopy. Cases with suspicious ultrasound findings were at a higher risk of CPPV than cases with normal findings (odds ratio, 13.800; P=0.004). A history of contralateral disease was also found to be a significant risk factor (odds ratio, 4.008; P=0.019). The present study identified that the significant risk factors for CPPV were suspicious findings on ultrasound examination and a history of contralateral disease. Therefore, it is concluded that performing inguinoscopy in children with these risk factors is beneficial.
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Affiliation(s)
- Dong-Gi Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lee
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kwan Hyun Park
- Seoul Samsung Urology Clinic/Gynecology Health Care Center, Ulsan, Republic of Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Wang WJ, Chen JZ, Fang Q, Li JF, Jin PF, Li ZT. Comparison of the Effects of Laparoscopic Hernia Repair and Lichtenstein Tension-Free Hernia Repair. J Laparoendosc Adv Surg Tech A 2013; 23:301-5. [PMID: 23573878 DOI: 10.1089/lap.2012.0217] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wei-Jun Wang
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Jun-Zhen Chen
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Qian Fang
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Jian-Feng Li
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Peng-Fei Jin
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Zhi-Tao Li
- Department of Minimal Invasive Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
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Feasibility of Incremental Laparoscopic Inguinal Hernia Repair Development in China: An 11-Year Experience. J Am Coll Surg 2013; 216:258-65. [DOI: 10.1016/j.jamcollsurg.2012.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 11/15/2022]
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Abstract
Inguinal hernia repair in infants is a routine surgical procedure. However, numerous issues, including timing of the repair, the need to explore the contralateral groin, use of laparoscopy, and anesthetic approach, remain unsettled. Given the lack of compelling data, consideration should be given to large, prospective, randomized controlled trials to determine best practices for the management of inguinal hernias in infants.
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Wang JH, Zhang W, Tou JF, Huang SJ, Liu WG, Xiong QX, Zhao ZY. Incidence of pediatric metachronous contralateral inguinal hernia in children aged ≥1 year. World J Pediatr 2012; 8:256-9. [PMID: 22886200 DOI: 10.1007/s12519-012-0367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The management of the contralateral asymptomatic side when a child with initial unilateral inguinal hernia undergoes herniorrhaphy continues to be controversial. Age less than 6 months at initial herniorrhaphy is considered as a high risk factor of the occurrence of metachronous contralateral inguinal hernia (MCIH). We performed herniorraphy for patients ≥1 year with initial unilateral hernia at one-day-set outpatient-surgery department without any intervention of contralateral groin. In this study, we reviewed the characteristics of development of MCIH in this condition and discuss the management strategies of MCIH. METHODS The subjects of this study were children who were treated at our outpatient-surgery department from January 2006 to December 2006. A total of 2129 patients with initial unilateral hernia and aged ≥1 year underwent an ipsilateral herniorhhaphy only. Patients were followed up for the development of MCIH to 60 months. The Chi-square test was used for intergroup comparison, a level of P<0.05 was considered as statistically significant. RESULTS Among these children 1341 (63.0%) were obtained 60 months follow-up data, 1146 (85.5%) were boys and 195 (14.5%) were girls. MCIH developed in 70 (5.2%) patients, 61 were boys and 9 were girls. In 570 patients aged 12-23 months, 43 developed MCIH (7.5%); in 564 patients aged 24-59 months, 21 developed MCIH (3.7%); and in 207 patients ≥60 months, 6 patients developed MCIH (2.9%), the difference between these groups was highly significant (P=0.004). In male patients, 30 right-sided MCIHs occurred after 423 initial left-sided herniorrhaphies (7.1%) and 31 left-sided MCIHs occurred after 723 initial right-sided herniorrhaphies (4.3%), difference between these two groups was significant (P=0.041). Seventy-seven percent of the MCIHs occurred within 1 year, 94% occurred within 2 years after initial herniorraphy. CONCLUSIONS As the overall incidence of MCIH in patients aged ≥1 year was 5.2%, routine contralateral groin exploration is not suggested. Transinguinal laparoscopy could be considered as an alternative of conventional "wait and see" policy, especially in patients less than 2 years or left-sided initial unilateral inguinal hernia. If "wait and see" policy is adopted, patients should be closely followed up for 2 years.
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Affiliation(s)
- Jin-Hu Wang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Draus JM, Kamel S, Seims A, Rescorla FJ. The Role of Laparoscopic Evaluation to Detect a Contralateral Defect at Initial Presentation for Inguinal Hernia Repair. Am Surg 2011. [DOI: 10.1177/000313481107701134] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH ( P = 0.0168). CPPV was associated with prematurity ( P = 0.0003) and age younger than 6 months ( P = 0.0001) but not with sex ( P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscope Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.
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Affiliation(s)
- John M. Draus
- Kentucky Children's Hospital and the Division of Pediatric Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sarah Kamel
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron Seims
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Frederick J. Rescorla
- James Whitcomb Riley Hospital for Children, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern. Pediatr Surg Int 2011; 27:953-61. [PMID: 21604078 DOI: 10.1007/s00383-011-2919-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Controversy still surrounds the treatment of the asymptomatic inguinal region in paediatric patients with a unilateral inguinal hernia. The concern is the development of a future metachronous contralateral inguinal hernia (MCIH) and therefore the need for a second operation. Our aim was to provide a current systematic review of the evidence for routine contralateral exploration, and identify potential at-risk groups. METHODS Comprehensive review of the literature utilising broad search terms to identify all relevant publications. Precise inclusion and exclusion criteria to identify studies that included paediatric unilateral inguinal hernia repair without routine contralateral exploration. DATA ANALYSIS Chi-square with Yates' correction or a Fisher's exact test as appropriate. Numbers needed to treat (NNT) calculated with 95% confidence intervals. RESULTS A total of 7,130 titles and abstracts were screened and 61 studies included with data on 49,568 paediatric patients with a unilateral inguinal hernia fulfilling the inclusion criteria. 2,857 of these patients later developed a MCIH, revealing an overall risk is 5.76% (95% CI: 5.55-5.97%). The NNT for a MCIH is 18 (95% CI: 16.8-18) with 18 contralateral exploration required for the prevention of one MCIH. Patients <6 months at the time of the initial intervention were more likely to develop a MCIH; 183/1,470 (<6/12) versus 144/2,044 (≥6/12), P < 0.0001. As were patients with an original left-sided hernia; 815/6,739 versus 865/12,615, P < 0.0001. The NNTs for both of these groups were 9. There was no association with the gender of the patient; 888/14,480 (♂) versus 268/4,206 (♀), P = 0.37. CONCLUSIONS There is insufficient evidence to support the routine contralateral inguinal exploration in all paediatric patients presenting with a unilateral inguinal hernia. However, with patients presenting with an originally left-sided hernia or who are less than 6 months old, a parental discussion should occur about the possible benefits and risks of contralateral exploration.
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