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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

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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.

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Acknowledgements

The authors would like to thank Dr. Shigeo Tobayama for granting us permission to use the historical data and Dr. Brendan Christopher Jones for his review and constructive comments for this manuscript.

Funding

Dr. Soichi Shibuya is supported by Japan Society for the Promotion of Science Overseas Research Fellowships (Grant Number 310072).

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan

    Soichi Shibuya, Takaaki Imaizumi, Susumu Yamada, Shiho Yoshida, Shunsuke Yamada & Toshiaki Takahashi

  2. Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan

    Soichi Shibuya, Takaaki Imaizumi, Susumu Yamada, Shiho Yoshida, Shunsuke Yamada, Toshiaki Takahashi & Eiji Miyazaki

  3. Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan

    Yoshie Toba

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  1. Soichi Shibuya
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Correspondence to Soichi Shibuya.

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Drs. Soichi Shibuya, Takaaki Imaizumi, Susumu Yamada, Shiho Yoshida, Shunsuke Yamada, Yoshie Toba, Toshiaki Takahashi, and Eiji Miyazaki have no conflicts of interest or financial ties to disclose.

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Shibuya, S., Imaizumi, T., Yamada, S. et al. 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. Surg Endosc 36, 941–950 (2022). https://doi.org/10.1007/s00464-021-08354-9

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