Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases
Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases
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DOI：
10.1007/s00464-015-4354-z
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发表时间：
2016-04-01
影响因子：
3.1
通讯作者：
Urushihara, Naoto
中科院分区：
文献类型：
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作者：
Miyake, Hiromu;Fukumoto, Koji;Urushihara, Naoto
近年来，腹腔镜下经皮腹膜外闭合术（LPEC）治疗小儿腹股沟疝越来越受欢迎。本研究的目的是比较LPEC和开放修复术（OR）在一个机构进行。在2003年7月至2008年6月期间，共有1050例患者接受了OR，1017例患者接受了LPEC从2008年7月至2013年6月。平均随访时间OR组为100个月，LPEC组为40个月（p < 0.01）。考虑到随访期的差异，使用对数秩检验分析长期结果。OR和LPEC的平均手术年龄分别为3.72岁和3.75岁（p = 0.81）。平均体重分别为14.73和14.72 kg（p = 0.98）。男性/女性比例分别为617/433和561/456（p = 0.10）。在LPEC手术中，常规观察无症状的对侧内环，当证实迷走突（PPV）通畅时，进行预防性手术，OR和LPEC单侧手术的平均手术时间分别为28.5和21.2 min（p < 0.01）。双侧手术的平均手术时间分别为52.3和25.4 min（p < 0.01）。OR中确认复发率为0.52%，LPEC中为0.27%（p = 0.53）。在LPEC组中，41.7%的临床单侧腹股沟疝患者被证实有对侧PPV，并接受了预防性LPEC。同侧异时性腹股沟疝（CMIH）在OR组为6.48%，在LPEC组为0.33%（P < 0.01）. 2例术后睾丸萎缩，2例术后出现医源性隐睾，而LPEC术后无睾丸并发症发生，从复发率和并发症来看，OR和LPEC均获得了满意的结果。与OR相比，预防性对侧LPEC可用于预防CMIH，而不会延长手术时间。LPEC的中期安全性和有效性已得到证实。
Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has become more popular. The aim of this study was to compare LPEC with open repair (OR) performed in one institution.In total, 1050 patients underwent OR from July 2003 to June 2008, and 1017 patients underwent LPEC from July 2008 to June 2013. The mean follow-up period was 100 months in OR and 40 months in LPEC (p < 0.01). Given the difference in the follow-up periods, the log-rank test was used for the analysis of the long-term results. The mean age at operation in OR and LPEC was 3.72 and 3.75 years, respectively (p = 0.81). The mean body weight was 14.73 and 14.72 kg, respectively (p = 0.98). The male/female ratio was 617/433 and 561/456, respectively (p = 0.10). In the LPEC procedure, the asymptomatic contralateral internal ring was routinely observed, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed.The mean operative time for unilateral surgery in OR and LPEC was 28.5 and 21.2 min, respectively (p < 0.01). The mean operative time for bilateral surgery was 52.3 and 25.4 min, respectively (p < 0.01). Recurrence was confirmed in 0.52 % in OR and in 0.27 % in LPEC (p = 0.53). In the LPEC group, 41.7 % of patients with clinically unilateral inguinal hernia were confirmed to have a contralateral PPV and underwent prophylactic LPEC. Contralateral metachronous inguinal hernia (CMIH) was seen in 6.48 % in OR and in 0.33 % in LPEC (p < 0.01). Two patients showed postoperative testicular atrophy, and two had iatrogenic postoperative cryptorchism after OR, while no postoperative testicular complications were seen after LPEC.Both OR and LPEC obtained satisfactory results from the perspective of recurrence rate and complications. Prophylactic contralateral LPEC is useful for preventing CMIH without prolonging operative time compared with OR. The midterm safety and efficacy of LPEC are proven.