SynthesisHernia : the journal of hernias and abdominal wall surgery2026
Optimal surgical approach to inguinal hernia repair in adolescents and young adults: is herniotomy alone adequate? a systematic review and meta-analysis.
Synthesis in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe optimal surgical approach for primary inguinal hernias (IH) in adolescents and young adults remains unclear because pediatric and adult treatment strategies often overlap. This systematic review and meta-analysis (SRMA) aimed to assess whether herniotomy alone (HA) is adequate compared with alternative repair (AR) techniques, using recurrence as the main outcome measure.
methodsThis review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261339925). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to March 20, 2026, for relevant studies. Studies including patients aged 10-30 years who underwent primary IH repair were included. The outcome was recurrence. A random-effects meta-analysis using log risk ratios (log RR) with 95% confidence intervals (CI) was conducted, and subgroup and sensitivity analyses were performed.
resultsTen studies (n = 42,726), including one randomized controlled trial (RCT) and nine observational studies, were included. HA was not associated with a statistically significant difference in recurrence compared with AR techniques (log RR 0.47, 95% CI - 0.17 to 1.10; p = 0.147) and had moderate heterogeneity (I² = 61%). Sensitivity analysis excluding one influential study showed a higher recurrence rate with HA (log RR 0.73, 95% CI 0.31-1.16; p < 0.001). Subgroup analyses based on age and repair type showed no significant differences. Certainty of evidence was low.
conclusionHA is a reasonable option for selected patients; however, neither HA nor AR techniques demonstrate clear superiority; therefore, an individualized approach is recommended for treating inguinal hernias in adolescents and young adults, incorporating selective reinforcement strategies based on patient and anatomical considerations.
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