Skip to main content

Advertisement

SpringerLink
Log in

A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports.

Methods

A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0.

Results

49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73–43.0%). The average of mean operative time was 19.56 min (range 8.30–41.19 min) for unilateral SLPEC and 27.23 min (range 12.80–48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0–3.24%), 0.05% (range 0–0.89%), 0.70% (range 0–15.5%), 0.23% (range 0–3.57%), 0.33% (range 0–3.33%), 0.05% (range 0–4.55%), and 0.03% (range 0–1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures.

Conclusions

SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lloyd DA, Rintala RJ (1998) Inguinal hernia and hydrocele. In: O’Neill JA Jr, Rowe MI, Grosfeld JC et al (eds) Pediatric surgery. Mosby, St. Louis, pp 1071–1086

    Google Scholar 

  2. Saranga Bharathi R, Arora M, Baskaran V (2008) Minimal access surgery of pediatric inguinal hernias: a review. Surg Endosc 22:1751–1762

    Article  PubMed  Google Scholar 

  3. Chang YT (2010) Technical refinements in single-port laparoscopic surgery of inguinal hernia in infants and children. Diagn Ther Endosc 2010:392847

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bharathi RS, Arora M, Baskaran V (2008) How we “SEAL” internal ring in pediatric inguinal hernias. Surg Laparosc Endosc Percutan Tech 18:192–194

    Article  PubMed  Google Scholar 

  5. Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Available at: http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf. Accessed 18 October 2016

  6. Shalaby R, Ismail M (2016) The use of epidural needle for single incision laparoscopic pediatric hernia repair: a novel technique. Surg Endosc 30:S152

    Google Scholar 

  7. Peng Y, Li C, Lin W, Xu L (2015) Application of a laparoscopic, single-port, double-needle technique for pediatric hydroceles with multiple peritoneal folds: a trial from a single-center 5-year experience. Urology 85:1466–1470

    Article  PubMed  Google Scholar 

  8. Liu W, Wu R, Du G (2014) Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: a novel technique. Hernia 18:345–349

    Article  CAS  PubMed  Google Scholar 

  9. Liu L, Li S, Li M, Yu Z (2013) Single-port laparoscopic assisted percutaneous extraperitoneal closure using an innovated apparatus for inguinal hernia in children. J Laparoendosc Adv Surg Tech A 23:A112

    Google Scholar 

  10. Muensterer OJ, Georgeson KE (2011) Multimedia manuscript: inguinal hernia repair by single-incision pediatric endosurgery (SIPES) using the hydrodissection-lasso technique. Surg Endosc 25:3438–3439

    Article  PubMed  Google Scholar 

  11. Shen W, Li W, Pan J (2010) A modified single-port technique for the minimally invasive treatment of pediatric inguinal hernias with high ligation of the vaginal process: the initial experience. J Endourol 24:A296

    Google Scholar 

  12. Chang YT, Wang JY, Lee JY, Chiou CS, Hsieh JS (2008) One-trocar laparoscopic transperitoneal closure of inguinal hernia in children. World J Surg 32:2459–2463

    Article  PubMed  Google Scholar 

  13. Yusheng N, Jie C (2016) Single-hole laparoscopic treatment in pediatric patients with inguinal hernia (908 cases analyze). Hernia 20:S96

    Google Scholar 

  14. Yehya A, Shalaby R, Abdalrazek A, Ibrahem R (2014) Single incision laparoscopic hernia repair in children; a preliminary report. Surg Endosc 28:S93

    Google Scholar 

  15. Gu Q, Li L, Ye H, Li X, Bai D, Zhang J (2013) The single port laparoscopic techniques for inguinal herniaandhydrocele in children. J Laparoendosc Adv Surg Tech A 23:A101

    Google Scholar 

  16. Granberg C, Gargollo P, Minkes R, Snodgrass W, Jacobs M (2012) Single-trocar laparoscopic herniorrhaphy in children. J Urol 187:e223

    Article  Google Scholar 

  17. Harrison MR, Lee H, Albanese CT, Farmer DL (2005) Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: a novel technique. J Pediatr Surg 40:1177–1180

    Article  PubMed  Google Scholar 

  18. Murase N, Uchida H, Seki T, Hiramatsu K (2016) A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature. Nagoya J Med Sci 78:19–25

    PubMed  PubMed Central  Google Scholar 

  19. Xu Q, Liu SQ, Niu JH, Luo RX, Zhang J, Zhang PF, Li XL, Peng F (2016) A new technique for extraperitoneal repair of inguinal hernia. J Surg Res 204:452–459

    Article  PubMed  Google Scholar 

  20. Obata S, Ieiri S, Jimbo T, Souzaki R, Hashizume M, Taguchi T (2016) Feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia by inexperienced pediatric surgeons: single-incision versus multi-incision randomized trial for 2 years. J Laparoendosc Adv Surg Tech A 26:218–221

    Article  PubMed  Google Scholar 

  21. Kozlov Y, Novozhilov V (2015) Technology of single-incision laparoscopic surgery in treatment of inguinal hernia in small babies. J Laparoendosc Adv Surg Tech A 25:526–530

    Article  PubMed  Google Scholar 

  22. Grimsby GM, Keays MA, Villanueva C, Bush NC, Snodgrass WT, Gargollo PC, Jacobs MA (2015) Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation. J Pediatr Urol 11(275):e1–e4

    Google Scholar 

  23. Timberlake MD, Herbst KW, Rasmussen S, Corbett ST (2015) Laparoscopic percutaneous inguinal hernia repair in children: review of technique and comparison with open surgery. J Pediatr Urol 11(262):e1–e6

    Google Scholar 

  24. Li S, Liu L, Li M (2014) Single-port laparoscopic percutaneous extraperitoneal closure using an innovative apparatus for pediatric inguinal hernia. J Laparoendosc Adv Surg Tech A 24:188–193

    Article  PubMed  Google Scholar 

  25. Uchida H, Kawashima H, Tanaka Y, Masuko T, Deie K, Iwanaka T (2013) Single-incision laparoscopic percutaneous extraperitoneal closure may be an alternative to standard minimally invasive surgical techniques for pediatric inguinal hernia. J Laparoendosc Adv Surg Tech A 23:A100–A101

    Article  Google Scholar 

  26. Chang YT, Lin JY, Lee JY, Tsai CJ, Chiu WC, Chiu CS (2012) Comparative mid-term results between inguinal herniotomy and single-port laparoscopic herniorrhaphy for pediatric inguinal hernia. Surg Laparosc Endosc Percutan Tech 22:526–531

    Article  PubMed  Google Scholar 

  27. Uchida H, Kawashima H, Goto C, Sato K, Yoshida M, Takazawa S, Iwanaka T (2010) Inguinal hernia repair in children using single-incision laparoscopic-assisted percutaneous extraperitoneal closure. J Pediatr Surg 45:2386–2389

    Article  PubMed  Google Scholar 

  28. Bharathi RS, Dabas AK, Arora M, Baskaran V (2008) Laparoscopic ligation of internal ring-three ports versus single-port technique: are working ports necessary? J Laparoendosc Adv Surg Tech A 18:891–894

    Article  PubMed  Google Scholar 

  29. Thomas DT, Göcmen KB, Tulgar S, Boga I (2016) Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: experience with 250 cases. J Pediatr Surg 51:1330–1335

    Article  PubMed  Google Scholar 

  30. Cui Z, Liu Y, Zhang W, Sun F (2016) Single-port laparoscopic percutaneous double ligation for pediatric inguinal hernias: report of a new technique and early results. Hernia 20:579–584

    Article  CAS  PubMed  Google Scholar 

  31. Erginel B, Akin M, Yildiz A, Karadag CA, Sever N, Dokucu AI (2016) Percutaneous internal ring suturing as a first choice laparoscopic inguinal hernia repair method in girls: a single-center study in 148 patients. Pediatr Surg Int 32:697–700

    Article  PubMed  Google Scholar 

  32. Li C, Xu L, Peng Y, Liang X, Lin W (2016) Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center. J Pediatr Urol 12(170):e1–e5

    Google Scholar 

  33. Ordorica-Flores R, Figueroa-Portillo R, Pérez-Escamirosa F, Lorias-Espinoza D, Minor-Martínez A, Olivares-Clavijo H, Zalles-Vidal C, Nieto-Zermeño J (2016) Pediatric inguinal hernia repair with a single-incision approach using an Endo Close™ suturing device. Surg Endosc 30(11):5134–5135

    Article  PubMed  Google Scholar 

  34. Li B, Nie X, Peng Y, Gong D, Xie Z, Mo Y, Xie H, Xu L (2016) Modified single-port laparoscopic herniorrhaphy for pediatric inguinal hernias: based on 3507 cases in China. Surg Endosc 20:S53

    Google Scholar 

  35. Ahmed H, Youssef MK, Salem EA, Fawzi AM, Desoky EA, Eliwa AM, Sakr AM, Shahin AM (2016) Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children. J Pediatr Urol 12(50):e1–e5

    Google Scholar 

  36. Shalaby R, Ismail M, Shehata S, Gamaan I, Yehya A, Elsayaad I, Akl M, Shams A (2015) Shalaby technique for efficient single incision laparoscopic pediatric inguinal hernia repair. J Pediatr Surg 50:1995–2000

    Article  PubMed  Google Scholar 

  37. Yilmaz E, Afsarlar CE, Senel E, Cavusoglu YH, Karaman I, Karaman A, Ozguner IF (2015) A novel technique for laparoscopic inguinal hernia repair in children: single-port laparoscopic percutaneous extraperitoneal closure assisted by an optical forceps. Pediatr Surg Int 31:639–646

    Article  PubMed  Google Scholar 

  38. Wang Z, Xu L, Chen Z, Yao C, Su Z (2014) Modified single-port minilaparoscopic extraperitoneal repair for pediatric hydrocele: a single-center experience with 279 surgeries. World J Urol 32:1613–1618

    Article  PubMed  Google Scholar 

  39. Li S, Li M, Wong KK, Liu L, Tam PK (2014) Laparoscopically assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children. J Pediatr Surg 49:1818–1820

    Article  PubMed  Google Scholar 

  40. Qi S (2013) Treatment of inguinal hernia in children with an umbilical single-incision laparoscopic percutaneous extraperitoneal closure using a syringe needle. J Laparoendosc Adv Surg Tech A 23:A103–A104

    Google Scholar 

  41. Xu C, Xiang B, Jin SG, Luo QC, Zhong L (2013) Transumbilical two-port laparoscopic percutaneous extraperitoneal closure: a new technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 23:392–396

    Article  PubMed  Google Scholar 

  42. Kumar A, Ramakrishnan TS (2013) Single port laparoscopic repair of paediatric inguinal hernias: our experience at a secondary care centre. J Minim Access Surg 9:7–12

    Article  PubMed  PubMed Central  Google Scholar 

  43. Li B, Nie X, Xie H, Gong D (2012) Modified single-port laparoscopic herniorrhaphy for pediatric inguinal hernias: based on 1,107 cases in China. Surg Endosc 26:3663–3668

    Article  PubMed  Google Scholar 

  44. Kimura T, Yamauchi K, Ihara Y, Sawai T, Kosumi T, Yonekura T (2012) Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique. Surg Today 42:100–103

    Article  PubMed  Google Scholar 

  45. Kastenberg Z, Bruzoni M, Dutta S (2011) A modification of the laparoscopic transcutaneous inguinal hernia repair to achieve transfixation ligature of the hernia sac. J Pediatr Surg 46:1658–1664

    Article  PubMed  Google Scholar 

  46. Wang DJ, Qiu JG, Fang YQ, Si TJ, Luo JB, Gao X (2011) Laparoscopic extraperitoneal repair of symptomatic hydrocele in children: a single-center experience with 73 surgeries. J Endourol 25:1221–1225

    Article  CAS  PubMed  Google Scholar 

  47. Yamoto M, Morotomi Y, Yamamoto M, Suehiro S (2011) Single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: an initial report. Surg Endosc 25:1531–1534

    Article  PubMed  Google Scholar 

  48. Chang YT, Lee JY, Tsai CJ, Chiu WC, Chiou CS (2011) Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children. J Laparoendosc Adv Surg Tech A 21:277–282

    Article  CAS  PubMed  Google Scholar 

  49. Shen W, Ji H, Lu G, Chen Z, Li L, Zhang H, Pan J (2010) A modified single-port technique for the minimally invasive treatment of pediatric inguinal hernias with high ligation of the vaginal process: the initial experience. Eur J Pediatr 169:1207–1212

    Article  PubMed  Google Scholar 

  50. Chang YT, Wang JY, Lee JY, Chiou CS (2009) A simple single-port laparoscopic-assisted technique for completely enclosing inguinal hernia in children. Am J Surg 198:e13–e16

    Article  PubMed  Google Scholar 

  51. Ozgediz D, Roayaie K, Lee H, Nobuhara KK, Farmer DL, Bratton B, Harrison MR (2007) Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: report of a new technique and early results. Surg Endosc 21:1327–1331

    Article  CAS  PubMed  Google Scholar 

  52. Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W (2006) Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 16:513–517

    Article  PubMed  Google Scholar 

  53. Tatekawa Y (2012) Laparoscopic extracorporeal ligation of hernia defects using an epidural needle and preperitoneal hydrodissection. J Endourol 26:474–477

    Article  PubMed  PubMed Central  Google Scholar 

  54. Shalaby R, Ismail M, Gouda S, Yehya AA, Gamaan I, Ibrahim R, Hassan S, Alazab A (2015) Laparoscopic management of recurrent inguinal hernia in childhood. J Pediatr Surg 50:1903–1908

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Natural Science Foundation of Ningbo Municipal Science and Technology Bureau-2016A610177.

Author information

Authors and Affiliations

  1. Department of Pediatric Urology, Ningbo Women and Children’s Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China

    Yi Chen, Furan Wang, Hongji Zhong, Junfeng Zhao, Yan Li & Zhan Shi

Authors
  1. Yi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Furan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongji Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junfeng Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhan Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Furan Wang.

Ethics declarations

Disclosures

Furan Wang has no conflicts of interest or financial ties to disclose.

Appendix

Appendix

PubMed

(“hernia, inguinal“[mh] OR hydrocele[mh] OR “inguinal hernia” OR “inguinal hernias” OR hydrocele OR hydroceles) AND (child[mh] OR infant[mh] OR adolescent[mh] OR child OR children OR infant OR infants OR baby OR babies OR pediatric OR pediatrics OR paediatric OR paediatrics OR adolescent OR adolescents) AND (laparoscopy[mh] OR laparoscopes[mh] OR laparoscopy OR laparoscopic OR coelioscopy OR coelioscopic OR celioscopy OR celioscopic OR peritoneoscopy OR peritoneoscopic OR endoscopy OR endoscopic OR laparoendoscopy OR laparoendoscopic OR minilaparoscopy OR minilaparoscopic OR laparoscope OR laparoscopes).

Embase

(‘inguinal hernia’/exp OR hydrocele/exp OR ‘inguinal hernia’ OR ‘inguinal hernias’ OR hydrocele OR hydroceles) AND (child/exp OR infant/exp OR adolescent/exp OR baby/exp OR child OR children OR infant OR infants OR baby OR babies OR pediatric OR pediatrics OR paediatric OR paediatrics OR adolescent OR adolescents) AND (laparoscopy/exp OR laparoscope/exp OR laparoscopy OR laparoscopic OR coelioscopy OR coelioscopic OR celioscopy OR celioscopic OR peritoneoscopy OR peritoneoscopic OR endoscopy OR endoscopic OR laparoendoscopy OR laparoendoscopic OR minilaparoscopy OR minilaparoscopic OR laparoscope OR laparoscopes).

Cochrane library

(“hernia, inguinal“[mh] OR hydrocele[mh] OR “inguinal hernia” OR “inguinal hernias” OR hydrocele OR hydroceles) AND (child[mh] OR infant[mh] OR adolescent[mh] OR child OR children OR infant OR infants OR baby OR babies OR pediatric OR pediatrics OR paediatric OR paediatrics OR adolescent OR adolescents) AND (laparoscopy[mh] OR laparoscopes[mh] OR laparoscopy OR laparoscopic OR coelioscopy OR coelioscopic OR celioscopy OR celioscopic OR peritoneoscopy OR peritoneoscopic OR endoscopy OR endoscopic OR laparoendoscopy OR laparoendoscopic OR minilaparoscopy OR minilaparoscopic OR laparoscope OR laparoscopes).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Y., Wang, F., Zhong, H. et al. A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Surg Endosc 31, 4888–4901 (2017). https://doi.org/10.1007/s00464-017-5491-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5491-3

Keywords

Search

Navigation