醫學六 B 林沅
A 4 month-old boy has a left inguinal palpable mass
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.
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.
Which one is better????
Ask (PICO): ask a clinical question (P-I-C-O) Acquire: search database (cite reference) Appraisal (VIP): Valid? Important? Practical? Apply: to patient’s problem (3 E evidence, experience, expectation) Audit: effectiveness ( Explain treatment options to you patient)
Patient/Problem: 4 month-old boy, inguinal hernia Intervention: open surgery repair Comparison intervention: laparoscope repair Outcomes
Inguinal hernia laparoscopic open
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
Ιa~Ib
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
No significantly different !!!
LH shorter than OH
No significantly different !!!
LH improve post op metachronic inguinal hernia
No significantly different !!! hydrocele Testicular atrophy
No significantly different !!! Wound infection Pain
Open Hreniorrhaphy V.S. Laparoscopic hreniorrhaphy Operative time(unilateral)No significant difference Operative time(bilateral)LH shorter than OH Duration of hospital stayNo significant difference Time to resume full activityNo significant difference Recurrent rateNo significant difference Contralateral herniaLH improve post op metachronic inguinal hernia HydroceleNo significant difference Testicular atrophyNo significant difference Wound infectionNo significant difference painNo significant difference
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