To analyze the safety and efficacy of laparoscopic herniorrhaphy (LH) compared with open high ligation of the hernia sac herniorrhaphy (OH) in children.

Strict inclusion and exclusion criteria were set up. Databases including CBMdisc, CNKI, Wanfang, PubMed and EMbase were searched. All the randomized controlled trials (RCT) on LH and OH for inguinal hernia from 1987 to 2018 were collected. Systematical analysis was performed according to the recommendation by the Cochrane handbook.

Eleven RCTs including 1508 patients were included in the analysis. They were divided into LH group (n=757) and OH group (n=751). Rate of testicular atrophy [OR=0.15, 95% CI (0.03, 0.84), P=0.03], total complications [OR=0.15, 95% CI (0.08, 0.26), P<0.000 01] and recurrence [RR=0.33, 95% CI (0.18, 0.62), P=0.000 5] were significantly lower in LH group compared to OH group. Compared with OH group, the operative time was significantly shorter in LH group for bilateral hernia repairs [MD=-8.82, 95% CI (-11.80, -5.83), P<0.000 01]. There was no difference between the two groups regarding operative time for unilateral hernia repairs [MD=-2.71, 95% CI (-7.96, 2.54), P=0.31]. There were no significant differences in the time before full activity [MD=-0.06, 95% CI (-0.66, 0.53), P=0.84] and analgetic dosage [MD=-0.84, 95% CI (-0.36 1.93), P=0.55] between the two groups.

In this meta-analysis, LH showed obvious advantages over OH, especially in reducing postoperative complications and recurrence. However, more high quality RCTs were needed to further supported it.