Surgery · Medical Literature
Absorbable versus non-absorbable suture in percutaneous laparoscopic inguinal hernia repair in children: a systematic review and meta-analysis.
Abstract
The optimal suture material for laparoscopic inguinal hernia repair in children remains controversial. This study aimed to compare the outcomes of absorbable sutures (AS) versus non-absorbable sutures (NAS), focusing on recurrence and suture-related complications. A systematic literature search was conducted in PubMed, Web of Science, and the Cochrane Library. Studies comparing AS and NAS in pediatric patients were included. Meta-analyses were performed using fixed- or random-effects models to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Four studies comprising 2803 patients in the AS group and 3507 in the NAS group were included. No significant differences were observed between AS and NAS for postoperative hydrocele (OR = 5.12, 95% CI 0.61-42.67; P = 0.13) or wound infection (OR = 0.94, 95% CI 0.44-2.01; P = 0.91). Suture knot reaction was significantly lower in the AS group (OR = 0.03, 95% CI 0.01-0.15; P < 0.0001). However, recurrence risk was significantly higher in the AS group (OR = 7.80, 95% CI 2.14-28.45; P = 0.002). Absorbable sutures significantly reduce suture knot reactions but are associated with a higher risk of recurrence compared to non-absorbable sutures. No significant differences were found for hydrocele or wound infection. Suture selection should balance these risks based on clinical priorities.
Clinical relevance
In children undergoing percutaneous laparoscopic inguinal hernia repair, does the use of absorbable suture (AS) versus non-absorbable suture (NAS) differ with respect to hernia recurrence, suture knot reaction, postoperative hydrocele, and wound infection? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis","setting":"Multi-database literature search (PubMed, Web of Science, Cochrane Library); specific institutional settings of included studies not reported in abstract","sampleSize":"n=6,310 total across 4 included studies (AS group: n=2,803; NAS group: n=3,507)","population":"Pediatric patients undergoing percutaneous laparoscopic inguinal hernia repair; specific age ranges, sex distribution, and hernia laterality of included patients not reported in abstract","intervention":"Absorbable suture (AS) for laparoscopic internal ring closure","comparator":"Non-absorbable suture (NAS) for laparoscopic internal ring closure","primaryOutcome":"Hernia recurrence rate; secondary outcomes included postoperative hydrocele, wound infection, and suture knot reaction — all assessed as dichotomous outcomes with odds ratios and 95% confidence intervals","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
Four studies (total n=6,310; AS: n=2,803, NAS: n=3,507) were included. For the primary outcome of recurrence, AS was associated with a significantly higher risk compared to NAS (OR=7.80, 95% CI 2.14–28.45; P=0.002), representing an approximately 7.8-fold increase in the odds of recurrence. NNH cannot be calculated without individual event-rate data (not reported in abstract). For suture knot reaction, AS was significantly superior to NAS, with a markedly lower odds of this complication (OR=0.03, 95% CI 0.01–0.15; P<0.0001), indicating a near-complete elimination of suture knot reactions with absorbable material. No statistically significant difference was identified between AS and NAS for postoperative hydrocele (OR=5.12, 95% CI 0.61–42.67; P=0.13) or wound infection (OR=0.94, 95% CI 0.44–2.01; P=0.91). The very wide confidence interval for the hydrocele outcome (0.61–42.67) indicates substantial imprecision, and this result must be interpreted with caution. Individual study event rates, absolute risk differences, NNT, and NNH are not reported in the abstract.
Practice implications
This meta-analysis establishes that, in children undergoing percutaneous laparoscopic inguinal hernia repair, the use of absorbable suture is associated with a statistically significant and likely clinically important increase in hernia recurrence risk compared to non-absorbable suture (OR=7.80). Conversely, non-absorbable sutures carry a substantially higher risk of suture knot reaction, a complication that, while often manageable, may require reoperation or additional intervention. The absence of significant differences in hydrocele and wound infection rates suggests these specific complications are not materially influenced by suture material choice, though the hydrocele estimate is highly imprecise. The findings appear most directly applicable to percutaneous laparoscopic techniques (e.g., LPEC and similar extraperitoneal approaches) and may not generalize to open or intracorporeal laparoscopic repair. Important patient subgroups — including neonates/infants, bilateral hernia patients, and those with incarcerated hernias — are not specifically characterized in the abstract. The meta-analysis is limited to only 4 studies, and since only an abstract was available for this review, the quality of included studies, heterogeneity statistics (I² values), risk-of-bias assessments, and the specific suture types categorized as 'absorbable' (e.g., short-term vs. long-term absorbable) are not verifiable. The trade-off between recurrence and knot reaction is the central clinical tension; given the primacy of durable repair in hernia surgery, current evidence favors NAS for minimizing recurrence, though individual patient factors and surgeon judgment remain relevant. __LIMITATIONS__ Only 4 studies included, limiting statistical power and generalizability.,Abstract-only availability: risk-of-bias assessments, heterogeneity statistics (I² values), and individual study quality cannot be independently verified.,The category 'absorbable suture' likely encompasses heterogeneous materials (e.g., short-term vs. long-term absorbable), which are not differentiated in the abstract — this is a critical source of potential clinical heterogeneity.,Follow-up duration is not reported; recurrence rates in inguinal hernia repair may accrue over years, and short follow-up would systematically underestimate true recurrence.,The hydrocele outcome estimate is severely imprecise (95% CI 0.61–42.67), precluding meaningful conclusions.,All included studies are likely observational (retrospective or prospective cohort); no randomized controlled trials are identified in the abstract, raising the risk of selection bias and confounding.,Absolute event rates and absolute risk differences are not reported, making NNT/NNH calculation impossible and limiting direct clinical applicability.,Generalizability is confined to percutaneous laparoscopic techniques; open repair and intracorporeal laparoscopic repair are not addressed.,Funding sources of both this review and the included studies are not reported, precluding assessment of potential conflicts of interest.,Patient-level demographic data (age, sex, hernia type/laterality, operator experience) are not reported, limiting assessment of subgroup applicability. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In children undergoing percutaneous laparoscopic inguinal hernia repair, absorbable sutures are associated with an approximately 7.8-fold higher odds of recurrence compared to non-absorbable sutures, while non-absorbable sutures carry a significantly higher risk of suture knot reaction. Given the primacy of durable hernia repair in children and the availability of low-profile monofilament non-absorbable alternatives, current evidence supports a preference for non-absorbable suture material, though this conclusion rests on only 4 studies — predominantly observational — and prospective comparative trials are needed before definitive guideline-level recommendations can be made.