Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

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• 作者：Hiromu Miyake ; ^{herohero6tti@gmail.com} ; Koji Fukumoto ; Masaya Yamoto ; Hideaki Nakajima ; Akinori Sekioka ; Yutaka Yamada ; Akiyoshi Nomura ; Naoto Urushihara
• 关键词：Inguinal hernia ; Laparoscopic percutaneous extraperitoneal closure
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：52
• 期：2
• 页码：317-321
• 全文大小：499 K
• 卷排序：52

文摘

The use of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has recently been increasing. Recurrence and contralateral metachronous inguinal hernia (CMIH) are important problems for LPEC. This study analyzed the risk factors for recurrence and CMIH.MethodsThis study included 1530 patients. The mean follow-up period was 48 months. Of 1530 patients, 847 were boys and 683 were girls. The mean age at operation was 3.9 years. The asymptomatic contralateral internal ring was routinely observed during the operation, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed.ResultsRecurrence was seen in 0.48% of patients (8/1653 sides), all of whom were male (P = 0.01: male versus female). On multivariate analysis, age less than 1 year was the only risk factor for recurrence in male patients (hazard ratio: 4.54, 95% CI: 1.07–19.25, P = 0.04). CMIH was seen in 0.22% of the patients (3/1382), again only in male patients (P = 0.12: male versus female). As a result of intraoperative observation, 44.6% of patients were confirmed to have an asymptomatic contralateral PPV and underwent prophylactic LPEC. Female, age 1 year or older, right side, and surgeon's experience were identified as factors associated with asymptomatic contralateral PPV.ConclusionsTo prevent recurrence, surgeons need to be careful when operating on young male patients. Whereas no specific factor could be identified as a risk factor for CMIH, some factors associated with asymptomatic PPV were identified. Further study and discussion will be needed to identify correlations between CMIH and these factors for PPV.Level of evidenceLevel III.