Abstract
Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.
Highlights
Inguinal hernia is one of the most common pediatric conditions managed operatively.The incidence of inguinal hernia in full-term (FT) newborns ranges from 1% to 5% and rises to 30% in premature newborns (PT) [1]
53 were excluded and only eight articles were eligible for full-text review. Four of these were further excluded as they were non-comparative studies (n = 2), compared the co-occurrence of inguinal hernia and patent processus vaginalis (PPV) among FT versus PT newborns (n = 1), and demonstrated Laparoscopic inguinal hernia repair (LHR) in newborns without any subgroup analysis (n = 1) [1,17,18,19]
The incidence of inguinal hernia in PT newborns is closely related to the patent processus vaginalis peritonei [1,8,21]
Summary
The incidence of inguinal hernia in full-term (FT) newborns ranges from 1% to 5% and rises to 30% in premature newborns (PT) [1]. In comparison with open surgery, the laparoscopic approach is equivalent in terms of surgical time, length of hospital stay (LOS), and recurrence rates, and allows the opportunity to explore and repair the contralateral side, preventing metachronous hernia [4]. Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following
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