title: A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele.
abstract: BACKGROUND
  Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports.
  
  
  METHODS
  A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0.
  
  
  RESULTS
  49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures.
  
  
  CONCLUSIONS
  SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China. pheonix925@hotmail.com.
authors.forename: Furan
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
authors.forename: Hongji
authors.initials: H
authors.lastname: Zhong
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Pediatric Urology, Ningbo Women and Children's Hospital, No. 266 Cishuixi street, Cicheng New Town, Jiangbei District, Ningbo, 315031, Zhejiang, China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Shi
mesh_terms: D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D010537:Peritoneum / Q000601:surgery; D006848:Testicular Hydrocele / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Children; Hydrocele; Inguinal hernia; Meta-analysis; Review; Single-site laparoscopy