title: Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases.
abstract: BACKGROUND
  Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has become more popular. The aim of this study was to compare LPEC with open repair (OR) performed in one institution.
  
  
  METHODS
  In total, 1050 patients underwent OR from July 2003 to June 2008, and 1017 patients underwent LPEC from July 2008 to June 2013. The mean follow-up period was 100 months in OR and 40 months in LPEC (p < 0.01). Given the difference in the follow-up periods, the log-rank test was used for the analysis of the long-term results. The mean age at operation in OR and LPEC was 3.72 and 3.75 years, respectively (p = 0.81). The mean body weight was 14.73 and 14.72 kg, respectively (p = 0.98). The male/female ratio was 617/433 and 561/456, respectively (p = 0.10). In the LPEC procedure, the asymptomatic contralateral internal ring was routinely observed, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed.
  
  
  RESULTS
  The mean operative time for unilateral surgery in OR and LPEC was 28.5 and 21.2 min, respectively (p < 0.01). The mean operative time for bilateral surgery was 52.3 and 25.4 min, respectively (p < 0.01). Recurrence was confirmed in 0.52% in OR and in 0.27% in LPEC (p = 0.53). In the LPEC group, 41.7% of patients with clinically unilateral inguinal hernia were confirmed to have a contralateral PPV and underwent prophylactic LPEC. Contralateral metachronous inguinal hernia (CMIH) was seen in 6.48% in OR and in 0.33% in LPEC (p < 0.01). Two patients showed postoperative testicular atrophy, and two had iatrogenic postoperative cryptorchism after OR, while no postoperative testicular complications were seen after LPEC.
  
  
  CONCLUSIONS
  Both OR and LPEC obtained satisfactory results from the perspective of recurrence rate and complications. Prophylactic contralateral LPEC is useful for preventing CMIH without prolonging operative time compared with OR. The midterm safety and efficacy of LPEC are proven.
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan. herohero6tti@gmail.com.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukumoto
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamoto
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nouso
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Kaneshiro
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Koyama
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D010537:Peritoneum; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Contralateral metachronous inguinal hernia; Laparoscopic inguinal hernia repair; Laparoscopic percutaneous extraperitoneal closure; Open herniorrhaphy; Pediatric inguinal hernia