Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis
- 22 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 36 (2), 941-950
- https://doi.org/10.1007/s00464-021-08354-9
Abstract
Background Despite a number of studies comparing laparoscopic inguinal hernia repair (LH) and open herniorrhaphy (OH), the putative advantage of LH remains controversial due to a paucity of firm evidence. We hypothesized that LH has both advantages and disadvantages compared to OH and sought to clarify them by comprehensively analyzing the retrospective data using the combination of multiple statistical methods. Methods Operative data for inguinal hernia during the period from February 1999 to December 2019 were examined. The patients were assigned into two groups according to the surgical procedure: laparoscopic percutaneous extraperitoneal closure (LPEC, n = 2410) and OH (n = 2038). Operative and anesthesia times and incidence of postoperative complications were evaluated using the propensity score methods and log-rank test. Results In comparison with OH, operative time of LPEC was longer for unilateral repair (21.59 ± 8.1 min vs 18.01 ± 8.0 min; p < 0.001) and shorter for bilateral repairs (28.55 ± 10.1 min vs 33.23 ± 11.7 min; p < 0.001), while anesthesia times were longer for both unilateral repair (57.67 ± 10.1 min vs 40.62 ± 11.9 min; p < 0.001) and bilateral repairs (65.95 ± 12.5 min vs 56.35 ± 15.1 min; p < 0.001). LPEC significantly reduced the risk of metachronous contralateral hernia (MCLH) (0.52% vs 9.29%; p < 0.001), but the recurrence rate was higher (0.21% vs 0.04%; p = 0.002) than OH. Orchiectomy due to testicular atrophy or torsion was required in 3 cases of OH (0.19%), whereas it was not seen in LPEC. Conclusions LPEC had a less risk of MCLH and testicular complications but was associated with a higher recurrence rate and longer anesthesia time. Propensity scoring techniques can enhance the robustness of retrospective comparisons between groups over several years of data collection, which is frequently required in pediatric surgery studies.Funding Information
- Japan Society for the Promotion of Science Overseas Research Fellowships (310072)
This publication has 40 references indexed in Scilit:
- Laparoscopic Hernia Repair versus Open Herniotomy in Children: A Controlled Randomized StudyMinimally Invasive Surgery, 2012
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on MortalityMultivariate Behavioral Research, 2011
- Fertility of men following inguinal hernia repairAndrologia, 2009
- Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphySurgical Endoscopy, 2009
- Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutionsJournal of Pediatric Surgery, 2006
- Prospective randomized single-center, single-blind Comparison of laparoscopic vs open repair of pediatric inguinal herniaSurgical Endoscopy, 2005
- Laparoscopic herniorrhaphy in childrenSurgical Endoscopy, 2003
- Laparoscopic evaluation of the pediatric inguinal hernia—A meta-analysisJournal of Pediatric Surgery, 1998
- Iatrogenic cryptorchidism resulting from hernia repair: G. W. Kaplan. Surg Gynecol Obstet 142:671–672 (May), 1976Journal of Pediatric Surgery, 1976