Efficacy And Safety Between Laparoscopic And Open Surgery Of Pediatric Inguinal Hernia:a Meta-analysis

Objective To assess the efficacy and safety between laparoscopic and open surgery of pediatric inguinal hernia.Methods All randomized controlled trials (RCTs) of laparoscopic and open surgery of pediatric inguinal hernia were searched from PubMed, Cochrane Library, EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, China national knowledge infrastructure and Digital Journal of Wanfang(from establishment to March2010), to assess operative time(unilateral), intraoperative blood loss, total postoperative complications, recurrence rate of inguinal hernia and time to resume normal daily activities after surgery. The quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version5.0.2. The Cochrane Collaboration’s software RevMan5.0was used for Meta-analysis.Result Five RCTs (586patients) were included. Compared with open surgery, laparoscopic surgery decreased intraoperative blood loss[MD=-1.35,95%CI(-1.80,-0.90), P<0.00001], but it extended operative time of unilateral hernia[MD=10.23,95%CI(4.33,16.14), P=0.0007]. However laparoscopic surgery cloud not increase the recurrence rate of inguinal hernia[RR=0.51,95%CI(0.15,1.73), P=0.28] and total postoperative complications[RR=0.16,95%CI(0.02,1.49), P=0.11], and aslo cloud not shorten the time to resume normal daily activities after surgery [SMD=-0.19,95%CI(-0.49,0.11), P=0.21].Conclusion The current evidence shows that laparoscopic surgery reduce intraoperative blood loss, and can not increase the recurrence rate or total postoperative complications, but can not shorten recovery time.On the contrary, it extends operative time of unilateral hernia. Further high-quality, long follow-up period RCTs should be carried out to provide more reliable evidence.