Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia

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Laparoscopic vs open herniorrhaphy in the
managementof pediatric inguinal hernia
??? B9502028 ??

• ??? B9502028 ??

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Case

• A 4 month-old boy has a left inguinal palpable
  mass

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Background Knowledge

• An inguinal hernia is a protrusion of soft
  tissues which are usually a part of the
  intestine, via a weak point or some tear in the
  lower abdominal wall. With this protrusion, there
  may be some pain in some conditions like when
  coughing, bending over and lifting a heavy
  object.

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Inguinal hernia repairment

• The most contentious aspect of inguinal hernia
  repair is the debate between proponents of the
  traditional open procedure and those who favor a
  laparoscopic approach.

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Laparoscopic versus open repair

• Which one is better????

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Perform Five Steps in EBM (5 As)

• Ask (PICO) ask a clinical question (P-I-C-O)
• Acquire search database (cite reference)
• Appraisal (VIP) Valid? Important? Practical?
• Apply to patients problem (3 E evidence,
  experience, expectation)
• Audit effectiveness ( Explain treatment options
  to you patient)

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Step 1---Ask (PICO)

• Patient/Problem 4 month-old boy,
• inguinal
  hernia
• Intervention open surgery repair
• Comparison intervention laparoscope repair
• Outcomes

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Step 2---Acquire
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Inguinal hernia laparoscopic open
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(No Transcript)
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Step 3---Appraisal
Randomized controlled trials (RCTs) and
observational clinical studies (OCSs) with a
comparison of LH and OH were included. A systemic
review and meta-analysis were performed using the
odds ratios (ORs) for dichotomous variables and
weighted mean differences (WMDs) for continuous
variables
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Step 4---APPLY

• What does the patient want to know?
• -Operative time
• -Duration of hospital stay
• -Time to resume full activity
• -Recurrent rate
• -Contralateral hernia
• -Complication of the operation

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Operative time of unilateral hernia
No significantly different !!!
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Operative time of bilateral hernia
LH shorter than OH
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Duration of hospital stay
No significantly different !!!
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Time to resume full activity
No significantly different !!!
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Recurrent rate
No significantly different !!!
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Contralateral hernia
LH improve post op metachronic inguinal hernia
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complications
hydrocele
No significantly different !!!
Testicular atrophy
No significantly different !!!
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complications
Wound infection
No significantly different !!!
Pain
No significantly different !!!
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Comparison summary
Open Hreniorrhaphy V.S. Laparoscopic hreniorrhaphy
Operative time(unilateral) No significant difference
Operative time(bilateral) LH shorter than OH
Duration of hospital stay No significant difference
Time to resume full activity No significant difference
Recurrent rate No significant difference
Contralateral hernia LH improve post op metachronic inguinal hernia
Hydrocele No significant difference
Testicular atrophy No significant difference
Wound infection No significant difference
pain No significant difference
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Step 5---audit

• Laparoscopic herniorrhaphy is superior to open
  repair in the repair of bilateral PIH and lower
  rate of metachronic contralateral hernia, with
  similar operative time for unilateral hernias,
  length of hospital stay,recurrence, and
  complication rates