title: Open Versus Laparoscopic Inguinal Herniotomy in Children: A Systematic Review and Meta-Analysis Focusing on Postoperative Complications.
abstract: OBJECTIVE
  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; I2=0%] as well as for bilateral hernias (95% CI, -12.18 to -3.79; I2=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; I2=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.
authors.affiliation: *Department of Pediatric Surgery, The Second Affiliated Hospital of Wenzhou Medical University †Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou ‡Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, Jiangsu, China.
authors.forename: Shaoguang
authors.initials: S
authors.lastname: Feng
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhao
authors.forename: Zhenqi
authors.initials: Z
authors.lastname: Liao
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Chen
mesh_terms: D002648:Child; D014943:Global Health; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D013526:Surgical Mesh; D016896:Treatment Outcome