Laparoscopic versus open inguinal hernia repair in pediatric age group: a systematic review and meta-analysis

To compare laparoscopic (LH) and open repair (OH) of pediatric inguinal hernia in a systematic way powered by evidence and meta-analysis to find evidenced guidelines for the current management of pediatric inguinal hernia. We searched for articles published between January 2011 and December 2020, which yielded 2777 results. After full screening, 26 studies were included in this meta-analysis. Twenty-six articles reporting on 111,770 patients (35,010 LH and 76,760 OH) were included. The meta-analysis showed that the laparoscopic hernia repair group had significantly shorter operative time than the open repair group particularly in bilateral cases. At the same time, laparoscopy is superior to conventional hernia repair as it provides the opportunity for inspection of contralateral groin and closure of patent processus vaginalis (PPV), if present, and minimizes the incidence of metachronous contralateral inguinal hernia (MCIH). With regard to post-operative scrotal edema and development of hydrocele, this meta-analysis showed superiority of laparoscopic hernia repair over conventional repair. Our results concluded that, the laparoscopic hernia repair is a preferred method for management of inguinal hernia in pediatrics over open herniotomy as it has a shorter operative time; lower risk of metachronous contralateral inguinal hernia, postoperative hydrocele, and its major benefit is for assessment of contralateral side of inguinal region so prevent development of MCIH.