Open Versus Laparoscopic Inguinal Herniotomy in Children: A Systematic Review and Meta-Analysis Focusing on Postoperative Complications

Purpose:There is an ongoing debate about whether laparoscopic or open herniorrhaphy (LH or OH) is the best choice for inguinal hernia in children. The aim of this study was to compare both of the surgical strategies as regards operative time, recurrence rate, postoperative complications by means of a systematic review, and meta-analysis of the available literatures.Methods:A systematic search for randomized clinical trials comparing OH and LH was conducted. Studies were reviewed for quality, inclusion and exclusion criteria, operative time for bilateral and unilateral hernias, recurrence, and complications.Results:Five randomized clinical trials with a total of 553 children (OH 278, LH 275) fulfilled the inclusion criteria and were analyzed in this review. Compared with OH, shorter operative time for unilateral hernias was noted in extraperitoneal approaches' group [95% confidence interval (CI), -6.71 to -3.71; I-2=0%] as well as for bilateral hernias (95% CI, -12.18 to -3.79; I-2=82%). Besides, less total postoperative complications was found in LH group, especially for major postoperative complications in male children (95% CI, 0.01-0.78; I-2=0%). However, no significant difference was observed between LH and OH in patients' recurrence.Conclusions:This meta-analysis favors LH in the repair of bilateral hernias and for unilateral hernias in extraperitoneal approaches' group. Total postoperative complications were significantly reduced in LH, especially for major postoperative complications in male children.