1. 醫學六 B9502028 林沅

2.  A 4 month-old boy has a left inguinal palpable mass

3.  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.

4.  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.

5. Which one is better????

6.  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)

7.  Patient/Problem: 4 month-old boy, inguinal hernia  Intervention: open surgery repair  Comparison intervention: laparoscope repair  Outcomes

9. Inguinal hernia laparoscopic open

11. 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

12. Ιa~Ib

13.  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

14. No significantly different !!!

15. LH shorter than OH

16. No significantly different !!!

19. LH improve post op metachronic inguinal hernia

20. No significantly different !!! hydrocele Testicular atrophy

21. No significantly different !!! Wound infection Pain

22. 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

23.  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