title: Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia.
abstract: BACKGROUND
  The use of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia has recently been increasing. Recurrence and contralateral metachronous inguinal hernia (CMIH) are important problems for LPEC. This study analyzed the risk factors for recurrence and CMIH.
  
  
  METHODS
  This study included 1530 patients. The mean follow-up period was 48months. Of 1530 patients, 847 were boys and 683 were girls. The mean age at operation was 3.9years. The asymptomatic contralateral internal ring was routinely observed during the operation, and when a patent processus vaginalis (PPV) was confirmed, prophylactic surgery was performed.
  
  
  RESULTS
  Recurrence was seen in 0.48% of patients (8/1653 sides), all of whom were male (P=0.01: male versus female). On multivariate analysis, age less than 1year was the only risk factor for recurrence in male patients (hazard ratio: 4.54, 95% CI: 1.07-19.25, P=0.04). CMIH was seen in 0.22% of the patients (3/1382), again only in male patients (P=0.12: male versus female). As a result of intraoperative observation, 44.6% of patients were confirmed to have an asymptomatic contralateral PPV and underwent prophylactic LPEC. Female, age 1year or older, right side, and surgeon's experience were identified as factors associated with asymptomatic contralateral PPV.
  
  
  CONCLUSIONS
  To prevent recurrence, surgeons need to be careful when operating on young male patients. Whereas no specific factor could be identified as a risk factor for CMIH, some factors associated with asymptomatic PPV were identified. Further study and discussion will be needed to identify correlations between CMIH and these factors for PPV.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. Electronic address: herohero6tti@gmail.com.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukumoto
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamoto
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sekioka
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nomura
authors.affiliation: Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Inguinal hernia; Laparoscopic percutaneous extraperitoneal closure