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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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Grech G, Shoukry M. Laparoscopic inguinal hernia repair in children: Article review and the preliminary Maltese experience. J Pediatr Surg 2022; 57:1162-1169. [PMID: 35210115 DOI: 10.1016/j.jpedsurg.2022.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the past two decades, laparoscopy has provided an alternative approach to inguinal hernia repair. The aim of this review is to carry out a retrospective systematic analysis of articles dealing with laparoscopic hernia repair in children and a review of the Maltese experience. METHODS Data was obtained from publications from 2002 to 2019. The endpoints include: patient demographics, clinical presentations, laparoscopic tools, ports, suture used, technical remarks, length of surgery, hospital stay, complications and follow-up. RESULTS 32 studies were included with a total of 10,183 patients. Most articles documented the use of 1 port. Length of surgery ranged from an average of 10 to 138 min. Ipsilateral recurrences were reported in 0.83% of cases, while 0.17% required conversion to open. PRELIMINARY MALTESE EXPERIENCE In our centre, a population of 514, 564 is covered (16% under the age of 18). A total of 14 cases of laparoscopic inguinal hernia repair were carried out from August 2018 till October 2020. The neonatal laparoscopic set-up involves a 30⁰ laparoscope, inserted via a 5 mm umbilical port, with 2 stab incisions allowing the use of 3 mm devices. Intra-corporeal purse string suture technique is used. The length of surgery ranged from 1 hr to 2 hr 30 min. There was 1 case of ipsilateral recurrence and another requiring conversion to open surgery. CONCLUSIONS Laparoscopic inguinal hernia repair in children is a versatile and safe procedure that can be carried out with minimal complications and low reoperation rates. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Gabriella Grech
- Department of Paediatric Surgery, Mater Dei Hospital, Triq Dun Karm, Msida MSD, 2090, Malta.
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Bruce ES, Hotonu SA, McHoney M. Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children. World J Surg 2021; 45:3609-3615. [PMID: 34458938 PMCID: PMC8572823 DOI: 10.1007/s00268-021-06295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
Background This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. Method A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups. Results 155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption. Conclusions Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.
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Affiliation(s)
| | - Sesi A Hotonu
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK
| | - Merrill McHoney
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK.
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Mohtashami S, Safa N, Guadagno E, Baird R, Poenaru D. Derivation of a complication burden score based on disability-adjusted life years to assess patient burden following surgery: a pilot study. Can J Surg 2020. [PMID: 33155974 DOI: 10.1503/cjs.004819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Comparing adverse outcomes following alternative surgical interventions is a complex process for both patients and providers. Disability-adjusted life years (DALYs) are used globally as a quantitative indicator of burden of disease. However, DALYs have not been applied to the burden of postoperative complications. This study explores the feasibility and utility of DALYs in measuring the burden of postoperative complications, using 2 pediatric surgical procedures as a test model. METHODS A literature review was undertaken of postoperative complications following pediatric inguinal hernia repair and intestinal atresia repair. Relevant studies were included, and incidence rates and durations of all key complications were identified. Using existing disability weights of equivalent health states to the complications, we estimated the burden in DALYs of each complication. These estimates were combined into a unitary procedure-specific complication burden score. RESULTS The key complications contributing to the postoperative burden following inguinal hernia repair were recurrence (0.016 DALYs), hydrocele (0.010), metachronous hernia (0.014) and port-site hernia (0.012). In the case of intestinal atresia repair, death (6.278), reoperation (12.100), stenosis (5.025) and anastomotic stricture (5.327) accounted for most of the postoperative DALYs. The complication burden score was 0.06 DALYs for inguinal hernia and 36.86 for intestinal atresia repair. CONCLUSION As a proof of concept, this study supports the feasibility of using DALYs to derive a complication burden score following surgical intervention, and to our knowledge it represents the first application of burden of disease metrics to postoperative adverse outcomes. Future studies should focus on deriving de novo disability weights for common postoperative complications and adverse outcomes.
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Affiliation(s)
- Sadaf Mohtashami
- From the Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que. (Mohtashami, Safa, Guadagno, Poenaru); and the Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, B.C. (Baird)
| | - Nadia Safa
- From the Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que. (Mohtashami, Safa, Guadagno, Poenaru); and the Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, B.C. (Baird)
| | - Elena Guadagno
- From the Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que. (Mohtashami, Safa, Guadagno, Poenaru); and the Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, B.C. (Baird)
| | - Robert Baird
- From the Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que. (Mohtashami, Safa, Guadagno, Poenaru); and the Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, B.C. (Baird)
| | - Dan Poenaru
- From the Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montréal, Que. (Mohtashami, Safa, Guadagno, Poenaru); and the Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, B.C. (Baird)
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Karakuş OZ, Ulusoy O, Ateş O, Hakgüder G, Olguner M, Akgür FM. Indirect inguinal hernia repair conducted with single conventional port intracorporeal conventional equipment-endoscopic surgery. Hernia 2020; 24:1063-1068. [PMID: 32152805 DOI: 10.1007/s10029-020-02165-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Laparoscopic or laparoscopy-assisted inguinal hernia repair (IHR) can be performed using one port plus two stab wounds. We herein present our experience with laparoscopic IHR conducted using a single conventional port and a single working instrument. METHODS The records patients who underwent single conventional port intracorporeal IHR during November 2013-December 2018 were evaluated. The main outcome measurements were patient's demographic characteristics, hernia side, presence of incarceration, operative time, and complications. RESULTS A total of 132 inguinal hernias (52 right, 40 left, and 20 bilateral) were repaired in 112 patients (76 boys, 36 girls). The mean ages of the patients were 69.8 ± 53.4 months (3 months to 17 years). In six patients, contralateral processus vaginalis was found to be patent during operation. Incarcerated inguinal hernia was present in two patients. Mean operative time was 17.9 ± 3.8 min (9-30 min) in unilateral hernias and 28.9 ± 6.5 min (24-45 min) in bilateral hernias. No intraoperative and postoperative complications were encountered. The mean hospital stay of the patients was 8.8 ± 5.0 h (4-36 h). Postoperative follow-up was 16.5 ± 5.1 months (6-24 months). No recurrent inguinal hernias were detected during follow-up. CONCLUSION Single conventional port intracorporeal IHR obviates additional stab wounds. Additionally, present technique eliminates the risk of skin puckering, subcutaneous granuloma, infection, nerve, and muscle damage development induced by the subcutaneously placed knot in laparoscopy-assisted IHR. Single conventional port intracorporeal IHR in children is a feasible and safe operative technique with low complication rates.
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Affiliation(s)
- O Z Karakuş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey.
| | - O Ulusoy
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - O Ateş
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - G Hakgüder
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - M Olguner
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
| | - F M Akgür
- Department of Pediatric Surgery, Medical School, Dokuz Eylül University, Balçova, 35340, Izmir, Turkey
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Laparoscopic versus open inguinal hernia repair in children: which is the true gold-standard? A systematic review and meta-analysis. Pediatr Surg Int 2019; 35:1013-1026. [PMID: 31292721 DOI: 10.1007/s00383-019-04521-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Hernia repair is one of the most common operations performed in children. Traditionally, an open surgical approach has been utilized; however, laparoscopic repair has been gaining favour within the surgical community. We aimed to determine whether open or laparoscopic hernia repair is optimal for pediatric patients by comparing recurrence rates and other outcomes. METHODS We searched CENTRAL, MEDLINE, and EMBASE from 1980 onwards, including studies that compared laparoscopic and open repair for pediatric inguinal hernia. RESULTS Our initial search yielded 345 unique citations. Of these, we reviewed the full text of 28, and included 21 in meta-analysis. The results showed that patients who underwent laparoscopic surgery were more likely to experience wound infection (p = 0.003), but less likely to experience ascending testis (p = 0.05) and metachronous hernia (p = 0.0002). There were no differences in recurrence rates (p = 0.95), surgical time (p = 0.55), length of hospitalization (p = 0.50), intra-operative injury, bleeding, testicular atrophy, or hydrocele. CONCLUSION Laparoscopic and open surgeries are equivalent in terms of recurrence rates, surgical time, and length of hospitalization. Laparoscopic repair is associated with increased risk of wound infection, but decreased risk of ascending testis. Laparoscopic surgery allows the opportunity to explore and repair the contralateral side, preventing metachronous hernia. LEVEL OF EVIDENCE III.
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Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review. Int J Surg 2019; 68:11-19. [DOI: 10.1016/j.ijsu.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/06/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
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Dann A, Shekherdimian S. Potential pitfalls of laparoscopic inguinal hernia repair in children: Case report of an unrecognized sliding hernia and review of other rare complications. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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