Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases

Hizuru Amano,Yujiro Tanaka,Michimasa Fujiogi,Hiroo Uchida,Keisuke Suzuki,Hiroshi Kawashima,Tadashi Iwanaka,Kyoichi Deie,Kaori Morita

doi:10.1007/s00464-017-5472-6

Abstract

BackgroudRecently, laparoscopic percutaneous extraperitoneal closure (LPEC) has gained increased popularity for pediatric inguinal hernia repair. To improve cosmesis, we developed single incision LPEC (SILPEC). The aim of this study was to assess the safety and feasibility of SILPEC compared with traditional open repair (OR).MethodsThis was a single-center retrospective cohort study of 2028 children who underwent inguinal hernia repair between April 2005 and August 2014. Nine hundred and ninety-five patients underwent OR and 1033 patients underwent SILPEC. Medical records were reviewed with respect to operative time, recurrence, incidence of contralateral metachronous inguinal hernia (CMIH), and complications. Patient satisfaction with cosmetic result was also investigated using questionnaires sent by mail. ResultsAll SILPEC procedures were completed without conversion. Operative time was longer in the SILPEC group than in the OR group for both unilateral and bilateral surgery regardless of sex (unilateral male: p = 0.0006, unilateral female: p < 0.0001, bilateral male: p < 0.0001, bilateral female: p < 0.0001). There was no statistically significant difference in recurrence rate (p = 0.43). The incidence of CMIH was significantly higher in the OR than in the SILPEC group (p < 0.0001). No postoperative testicular atrophy was found in either group. There was no statistically significant difference in ascending testis (p = 0.09), but the frequency of surgical site infection was higher in the SILPEC than in the OR group (p = 0.0013). According to the questionnaire, operative scar was more invisible in the SILPEC than in the OR group (p < 0.0001), but both procedures had equally high levels of satisfaction for cosmetic results (p = 0.58). ConclusionSILPEC proved to be a safe and feasible procedure compared with OR with an equally low recurrence rate, more effectiveness for preventing CMIH, and more invisible scar.

Highlights

IntroductionInguinal herniorrhaphy is one of the most common surgical procedures
In pediatric surgery, inguinal herniorrhaphy is one of the most common surgical procedures
The operator stood on the opposite side to the inguinal hernia, and the camera assistant stood on the other side

Summary

Introduction

Inguinal herniorrhaphy is one of the most common surgical procedures. Laparoscopic procedures for pediatric inguinal hernia repair have gained increased popularity, and numerous techniques have been reported [1,2,3,4]. Laparoscopic percutaneous extraperitoneal closure (LPEC), first described by Takehara et al [5], has been widely accepted as one of the most simple and reliable methods for pediatric inguinal hernia repair. There are some comparative reports of conventional open repair (OR) and LPEC [7,8,9], none has compared OR and SILPEC. Surg Endosc (2017) 31:4988–4995 retrospective cohort study including 2028 children who underwent inguinal hernia repair to compare the safety and efficacy of OR and SILPEC at Saitama Children’s Medical Center in Japan.

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