Clinical data
From 2014 to 2018, a total of 3,243 cases were recorded, mean age was 14.74±23.14 years, the minimum age was 4 months,the oldest age was 93 years old; mean medical history was1.63±5.62 years, the longest was 70 years, was a 78-year-old man, appearance of the initial symptoms when he was 8 years old (51 cases onset-age less than 15 years old, ratio to 6.76%).
2489 cases in children group, mean age was 3.36±2.47 years, mean medical history was 0.74±2.71 years, right-sided IH 1409 (56.69%) cases, left-sided IH 975 (39.17%), bilateral IH 103 (4.14%) (Table 1). Statistics show, both onset age-case and repair age-case declined rapidly at younger ages (R2=0.9715, 0.8806) (Fig.2).
754 cases in adult group, mean age was 53.65±17.40 years, mean medical history was 4.57±10.00 years (children VS adults, t=17.10, p< 0.0001), right-sided IH 487 (64.32%) cases, left-sided IH 236 (31.30%) (children VS adults, χ2 =15.39, P < 0.0001), bilateral IH 33 (4.38%) (χ2 =0.082, P =0.7747) (Table 1). The case ratio of children VS adults was 3:1, the age-range ratio of the groups was 1:5.
Table 1 Clinical details included in the study.
|
Boys
|
Men
|
t /χ2
|
p
|
Total(T)
|
2489
|
754
|
|
|
Mean age(years)
|
14.73±23.14
|
|
|
Team mean age(years)
|
3.36±2.47
|
53.65±17.40
|
|
|
Min age(months)
|
4
|
|
|
|
Max age(years)
|
|
93
|
|
|
Team median age(years)
|
2.5
|
55
|
|
|
Median age(years)
|
8
|
54
|
|
|
Case ratio
|
3:1
|
|
|
Age-range ratio
|
1:5
|
|
|
Right(R)/%
|
1411
|
56.69
|
485
|
64.32
|
15.39
|
0.0001 #
|
Left(L)/%
|
975
|
39.17
|
236
|
31.30
|
Bilateral(B)/%
|
103
|
4.14
|
33
|
4.38
|
0.082
|
0.7747 ##
|
History(years)
|
0.74
|
4.57
|
17.10
|
< 0.0001 ###
|
#χ2 test, ##(R+L) VS B, χ2 test, ###Unpaired t test.
Children vs Adults
At laparoscopy, 1124 (47.11%) CPPV were checked in 2386 unilateral IH of children, just 12 (4.49%) CPPV in 267 unilateral IH of adults (χ2=178.1, P<0.0001). The CPPV on the right side was identified in 50.77% of the children with left unilateral IH, compared with 44.58% on the left in children with right inguinal hernia (χ2=8.869, P=0.0029). Just 5.26% in right-sided IH vs 4.19% in left-sided IH of adult (χ2=0.1463, P = 0.7021). The incidence of CPPV was significant difference between the same-sided of groups (Left IH: χ2 =58.55, P<0.0001; Right IH: χ2 =114.6, P < 0.0001) (Table 2).
Table 2 Clinical details of unilateral IH in boys and men included in the study.
|
boys
|
men
|
χ2
|
p
|
T
|
2386
|
267
|
|
|
R/%
|
1411
|
59.14
|
191
|
71.54
|
|
|
L/%
|
975
|
40.86
|
76
|
28.46
|
15.43
|
< 0.0001
|
CPPV/%
|
1124
|
47.11
|
12
|
4.49
|
178.1
|
< 0.0001
|
CPPV-L/%
|
495
|
50.77
|
4
|
5.26
|
114.6
|
< 0.0001
|
CPPV-R/%
|
629
|
44.58
|
8
|
4.19
|
58.55
|
< 0.0001
|
|
|
|
8.869#
|
0.0029
|
|
|
|
0.003##
|
0.9560
|
CPPV-R: CPPV of right-sided IH; CPPV-R: CPPV of left-sided IH; #CPPV-R vs CPPV-L in boys, ## T (theoretical frequency)=3.42<5, Chi-square with Yates' correction, CPPV-R vs CPPV-L in adult.
Younger vs Elder of children
Two groups were generated: younger group including younger than 18 months with a total of 576 cases, right-sided IH 311 (53.99%) cases, left-sided IH 225 (39.06%), bilateral IH 40 (6.94%), mean age was 13.72±3.48 months, mean medical history was 4.92±4.54 months; elder group including children older than 60 months with a total of 538 cases, right-sided IH 275 (51.12%) cases, left-sided IH 253 (47.03%) (right-sided VS left-sided, χ2=3.792, P=0.0515), bilateral IH 10 (1.86%) (χ2=16.78, P<0.0001), mean age was 87.15±25.30 months, mean medical history was 16.10±25.71 months (t=10.26, p< 0.0001).
256 (47.76%) CPPV were checked in 536 unilateral IH of younger group, 225 (42.61%) CPPV in 528 unilateral IH of elder group (χ2=2.845, P=0.0916). The CPPV on the right side was identified in 48.89% of the younger group with left unilateral IH, compared with 46.95% on the left in children with right inguinal hernia (χ2=0.1977, P= 0.6566). 49.01% in left-sided IH vs 36.73% in right-sided IH of elder group (χ2=8.132, P=0.0043). The incidence of CPPV was significant difference on right-sided between the groups (Left IH: χ2=0.0007206, P=0.9786; Right IH: χ2=6.249, P=0.0124) (Table 3).
Table 3 Clinical details of younger and elder boys included in the study.
|
Younger
|
Elder
|
t /χ2
|
p
|
Age range(months)
|
≤18[4-18]
|
≥60[60-180]
|
|
|
T
|
576
|
538
|
|
|
R/%
|
311
|
53.99
|
275
|
51.12
|
|
|
L/%
|
225
|
39.06
|
253
|
47.03
|
3.792
|
0.0515
|
B/%
|
40
|
6.94
|
10
|
1.86
|
16.78
|
< 0.0001
|
CPPV/%
|
256
|
47.76
|
225
|
42.61
|
2.845
|
0.0916
|
CPPV-L/%
|
110
|
48.89
|
124
|
49.01
|
0.000721
|
0.9786
|
CPPV-R/%
|
146
|
46.95
|
101
|
36.73
|
6.249
|
0.0124
|
|
|
|
0.1977#
|
0.6566
|
|
|
|
8.132##
|
0.0043
|
History(months)
|
13.72
|
16.08
|
2.182###
|
0.0293
|
#CPPV-R vs CPPV-L in younger, ##CPPV-R vs CPPV-L in elder, ### Unpaired t test.
Follow up
A total of 2329 (93.57%) children was followed up at least 2 years by the ways, recurrence rate of children was 0.73% (17 of 2329). Recurrence rate of contralateral clogged processus vaginalis (PV) at laparoscopy was 0.32% (4 of 1262), the rate of repair-sided was 0.35% (13 of 3716), the rate of IH-sided was 0.39% (10 of 2592), the rate of CPPV-sided was 0.35% (3 of 1124), there were no significant differences between the blocks (Fig.3).