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Year : 2022  |  Volume : 27  |  Issue : 6  |  Page : 689-698

A bibliometric study of the pediatric inguinal hernia publication landscape from the web of science database

1 Department of Pediatric Surgery, All India Institute of Medical Sciences, Delhi, India
2 Central Library, Indian Institute of Technology, Delhi, India
3 NDDTC, All India Institute of Medical Sciences, Delhi, India

Date of Submission08-Feb-2022
Date of Decision16-Jun-2022
Date of Acceptance30-Jul-2022
Date of Web Publication11-Nov-2022

Correspondence Address:
Anjan Kumar Dhua
Room No. 4002, Department of Pediatric Surgery, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaps.jiaps_27_22

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Background: The number of times a research work gets cited by another article is one of the article-level metrics for assessing the quality of a research publication. Citation analysis by bibliometric review has been performed in several disciplines. The current study was aimed to systematically review the literature available on pediatric inguinal hernia since 1960 in terms of the 25 most cited articles in this field and analyze the bibliometric variables author and organizational collaborative patterns.
Methods: Thomson Reuters Web of Science citation indexing database and research platform were used to retrieve the most cited articles in pediatric inguinal hernia (PIH) using appropriate search strings. The characteristics (name of authors, the total number of authors, the title of publication, journal of publication, year of publication, etc.) of the 25 top-cited articles were recorded. Specific bibliographical parameters were derived and analyzed. Visualization maps were generated using VOSviewer software.
Results: The analysis revealed that the Journal of Pediatric Surgery was leading the choice of journal for publication. While most of the publications originated from the United States of America, Schier was the most influential author. Five of the eight top-productive authors are also the most connected.
Conclusion: Articles on laparoscopic repair in PIH have been heavily cited. Following the United States of America, Turkey stands out as the topmost productive country in PIH. The publications on PIH show that “collaboration” is the bridging force between productivity and influence on the academic community.

Keywords: Bibliometrics, citation, citation analysis, co-authorship link, h-index, pediatric inguinal hernia

How to cite this article:
Dhua AK, Garg M, Mishra AK, Goel P, Jain V, Yadav DK. A bibliometric study of the pediatric inguinal hernia publication landscape from the web of science database. J Indian Assoc Pediatr Surg 2022;27:689-98

How to cite this URL:
Dhua AK, Garg M, Mishra AK, Goel P, Jain V, Yadav DK. A bibliometric study of the pediatric inguinal hernia publication landscape from the web of science database. J Indian Assoc Pediatr Surg [serial online] 2022 [cited 2022 Dec 7];27:689-98. Available from: https://www.jiaps.com/text.asp?2022/27/6/689/360955

   Introduction Top

The bibliometric landscape on pediatric inguinal hernia (PIH) has remained largely unexplored. The explosive increase in the number of surgical and biomedical journals together with the “publish or perish” culture in academic institutes has led to the accretion of a huge number of manuscripts in several journals. The preferred journals are those with high-impact factor but for a focused subject as narrow as “pediatric inguinal hernia” the research work may not get a due place in such highly ranked journals. However, several other pediatric surgery-specific journals included in MEDLINE/PubMed and Science Citation Index are good hosts for high-quality studies. Bibliometric analysis can delineate the exact stance of the journals toward papers on this topic and counter or agree to our assumption the way such articles get published.

The number of citations a paper accrues over time has long been considered as a “metric” of the quality of the research work dealt by that paper, although it is not the only factor for determining the scientific merit. The earliest possible example was notably published in the Journal of the American Medical Association for the most cited articles in the same journal by Garfield in 1987.[1] Subsequently, several surgical specialties such as general surgery, plastic surgery, trauma, orthopedic surgery, cardiothoracic surgery and even pediatric surgery have deployed bibliometric analysis in different dimensions.[2],[3],[4],[5],[6] However, the territory of PIH remains unexplored on this front.

The present study was done to systematically review the literature available on PIH since 1960 in terms of the 25 most cited articles in this field, analyze specific bibliometric characteristics and also study the country, organizational and author collaborative patterns using visualization maps.

   Methods Top

On November 1, 2021, the Web of ScienceTM core collection (WoS) was queried with the string “pediatric” AND “inguinal” AND “hernia” limited to articles from 1960 to 2018. The specified words were searched in all fields (title, abstract, text, keywords, etc.) in the database of WoS.

Data analysis

All data were downloaded in.txt and.xls format. The data were opened in Microsoft® Excel Version 16.49 and analyzed further. Different parameters were extracted from WoS, including the h-index, the total research output and trend over years, total citations accrued and the trend over the years, the type of the article (article, review, letter, corrections, editorial material, proceeding papers, meeting abstracts, etc.); the top productive countries, journals, authors, and the organizations. For the purpose of calculating the citations accrued and its derived variables, the cutoff date was October 31, 2021. The various article-level metrics used in the current study to compare the citations accrued by the top-25 articles, Countries, Organization, Journal, and authors were the citations per item (CPI) and Citations per publication per year (CPIPY) (calculated to nullify the effect of article life upon citations accrued).

Top 25 articles

The top-25 most cited is lined up based on the number of citations received. The full texts were read. Each article was evaluated with respect to the complete list of the authors; the name of the journal; main field of the journal (pediatric surgery, surgery, anesthesia, pediatrics, and others); year of publication, and the main subject area of the study (surgical technique open, surgical technique laparoscopic, anesthesia, others).

Visualization maps

We used VOSviewer software (Version-1.6.16 [0]) (Leiden University, Leiden, Netherlands). It is a software tool for building and depicting networks based on bibliometric data. It features a text mining instrument that can be used to depict co-occurrence networks of terms extracted from any part of scientific literature.[7]

Country co-authorship, author co-authorship links were presented as network visualization maps. In VOSviewer maps, the size of the label and the circle of an item are determined by the weight of the item. The higher its weight, the larger its label, and circle. The color of an item is determined by the cluster to which the item belongs. Lines between items represent links. The distance between two items in the visualization approximately indicates the relatedness of the items in terms of co-authorship or co-occurrence link.[7]

Research ethics

The primary data were downloaded from WOS; the current analysis was meant to generate secondary data from the existing data and no interaction with animal or human subjects was involved. Since there were no ethical issues with this approach, an ethics committee clearance was not sought.


Descriptive statistics are used to describe the bibliometric profiles. The summary information (journal, year of publication, number of citations, and the average citations received per year) of the top-25 most cited articles in PIH is depicted in [Table 1]. The test of significant difference in the proportion of articles and citations was assessed by the Z-test for two proportions. The citation per article (CPY) was a ratio statistic. The null hypothesis under this scenario was that the rate ratio of citation across two specialties was equal to one against the alternative hypothesis that it is different from one. This was assessed with the help of a suitable R command by declaring the variable total citations and the total cited article as the vector and applying the Exact Rate Ratio Test, assuming Poisson Count. P < 0.05 was considered to be statistically significant. Data entry was done using Microsoft Excel®, and statistical analysis was performed using licensed Stata/SE version 12.0.
Table 1: The top-twenty five most cited articles in pediatric inguinal hernia

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   Results Top

The query returned 1193 manuscripts, receiving a total of 17,792 citations, 11365 citations (without self-citations) at an average of 14.91 citations per manuscript, h-index of 55, authored by 4363 authors from 73 countries and published in 212 journals. Sixty-five percent of these manuscripts (n = 776) were published in ten journals.

The most productive year was 2016 with 66 manuscripts published. The year-wise count and the cumulative counts of the manuscripts are depicted in [Figure 1].
Figure 1: The year-wise count and the cumulative counts of the manuscripts

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The plot depicts a very slow rise till 1990, and then, a steep rise is appreciable from 1990 onwards. The combined year-wise trends (number of publications and citations) are shown in [Figure 2].
Figure 2: Year-wise distribution of the number of articles and citations received in PIH superimposed. PIH: Pediatric inguinal hernia

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The 17792 (range of 0 to 361) citations were received by 86.8% (n = 1036) manuscripts while 13.2% (n = 157) manuscripts did not receive any citation. The highest citations were accrued in the year 2020 with 1652 citations (9.2% of 17792). The average number of citations received per year is 291.6. Other aspects of the citation analysis are depicted in [Figure 3].
Figure 3: Distribution of citations accrued across the articles and their analysis

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Close to 80% of the publications were research articles. The distribution of the type of publications is graphically below depicted in [Figure 4].
Figure 4: Distribution of the publications based on type

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Top-25 Cited articles

The characteristics of the top-25 cited articles are presented in [Table 1]. The differences observed among the top-25 cited articles published in pediatric surgery specific journal (PSSJ) or otherwise (nonpediatric surgery specific journal [NPSSJ]) are shown in [Table 2].
Table 2: The differences observed among the top-25 cited articles published in pediatric-surgery specific journal or otherwise (nonpediatric surgery specific journal)

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Journal (overall)

The journals publishing the most cited journals their various bibliographic parameters to characterize them are shown in [Table 3].
Table 3: Top journals with their various bibliographic parameters

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Country of origin of articles (overall)

The geographical origin of research in PIH from 73 countries is illustrated in the choropleth map [Figure 5]. The top-ten countries with their contribution (absolute and percentage of 1193) are listed in [Table 4].
Figure 5: Choropleth map illustrating the global publication pattern in terms of country of origin

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Table 4: Top-10 countries ranked according to their productivity and other bibliographic parameters

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Organization (overall)

The top five institutes and their bibliometric characteristic features are displayed in [Table 5].
Table 5: Top five institutions lined up according to their productivity and other bibliographic parameters

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Author (overall)

The bibliometric characteristics of the top-prolific authors are described in [Table 6].
Table 6: Top authors ranked according to their productivity and other bibliographic parameters

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Visualization maps depicting collaboration

Collaborative links were generated with “country”, “organization” and “authors” as the units for generating co-authorship link strength in VOSviewer software.

Country-wise co-authorship links

For assessing the collaboration links between countries, the threshold chosen was a minimum number of five documents. Thirty-three countries met the criteria, but five countries were excluded because the link strength was zero. Using these criteria, 28 items in 7 clusters with 123 links and a total link strength of 237 were identified [Figure 6]. The United States of America (USA) stands out on the map as the most prominent node with the highest international collaboration (documents-329, links-123, and link strength-65), followed by Italy (documents-57, links-17, and link strength-55), and Germany (documents-56, links-17, and link strength-43).
Figure 6: VOSviewer generated visualization map demonstrating collaborative links between countries

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Organization wise co-authorship links

For assessing the collaboration links between organizations, the threshold chosen was a minimum number of five documents. Out of 1183 organizations, 70 met the criteria, but 20 organizations were excluded because the link strength was zero. Using these criteria, 50 items in 8 clusters with 119 links and a total link strength of 184 were identified [Figure 7]. The Royal Children's Hospital, Melbourne (documents-24, links-7, and link strength-31), Murdoch Children's Research Institute, Melbourne (documents-13, links-7, and link strength-30).and the University of Melbourne were the top three collaborators (documents-12, links-7, and link strength-29).
Figure 7: VOSviewer generated visualization map demonstrating collaborative links between organizations

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Collaborative links between authors

The collaboration links between authors were calculated after setting a threshold of a minimum number of five documents. Thirty authors met the criteria. After analysis, 13 authors were considered for mapping as the rest 17 had a link score of zero. These 13 authors were found in 3 clusters with 21 links and a total link strength of 69 [Figure 8]. Esposito, C (documents-18 and link strength-30), Settimi, A (documents-12, and strength-25).and Escolino M, (documents-8 and link strength-21) were the top three authors in terms of collaborative links.
Figure 8: VOSviewer generated visualization map demonstrating collaborative links between authors

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   Discussion Top

Our study explored the bibliometric parameters and the citation counts of the articles related to pediatric inguinal hernias which are under the ambit of the WOS database. It is a general understanding that increases in the number of articles in any field would lead to a parallel rise in the citation counts. A bibliometric study on abdominal wall hernias in adults and general noted that there was a 2.3- and 2.0-fold general growth in citation counts for herniology papers between 1980 and 2010.[8] As regards the pediatric inguinal hernia is concerned, although the principle of management and surgical repair has remained largely unchanged, there have been several different approaches to achieve the same result has come up. This and several other subjects have remained open for research including the anesthesia approach, long term effects of anesthesia in kids, as well as routine exploration for an opposite patent processus vaginalis, may have contributed to a massive boom in the number of publications from the year 1990 onwards, and thereafter, it seems that the number of publications has not reached a peak yet. The total citations accrued for these articles also rose parallel to the trend as observed for the number of articles published per year.

The number of citations an article receives showcases the interests of the researchers in that subject. Studying the frequently cited articles provides information on the important topics and the attention and growth in research a particular area has received. When the bibliometric analysis of the research pertaining to PIH was performed, it was noticed that the most frequently cited broad subject area was surgical technique followed by anesthesia. This pattern is not unexpected since PIH is one of the most performed surgeries by a pediatric surgeon and the surgical technique has evolved off late with the availability of newer approaches such as laparoscopy, although the core principles of surgery has remained unchanged. Laparoscopy has stimulated the surgeons to address the anatomical problem (patent processus vaginalis) with new techniques and to study and compare these new techniques in terms of feasibility and the outcomes. Closely following the surgical techniques are the publications related to anesthesia in PIH related to long-term outcomes of anesthesia, inhalational agents, analgesia techniques and drugs, intraoperative monitoring strategies, etc., It may be noted that amongst the top three highly cited articles are on anesthesia probably indicating the larger audience and wider dispersibility of these articles thereby standing a higher chance of accruing more citations.

When analyzed in-depth, all the articles (n = 12) on surgical technique among the top-25 cited articles have dealt on laparoscopic technique, except three. It becomes apparent that the various techniques like the “subcutaneous endoscopically assisted ligation technique”, “percutaneous internal ring suturing” and conventional laparoscopic technique have attracted the attention of the researchers and surgeons both alike and have been therefore cited heavily.

The highest number of articles in the list of top-25 was published in the Journal of Pediatric Surgery (JPS). It is noteworthy to note that the JPS is the official journal of several professional societies (Section on Surgery of the American Academy of Pediatrics, the British Association of Pediatric Surgeons, the American Pediatric Surgical Association, the Canadian Association of Pediatric Surgeons, and the Pacific Association of Pediatric Surgeons). Therefore, it is understandable that JPS would be receiving high-standard submissions and leading to a significantly large number of influential papers in PIH. As far as the proportion of articles published in the pediatric surgery-specific journal (PSSJ) or NPSSJ is concerned, the top-25 cited articles showed a significant difference (PSSJ/NPSSJ: n = 15/n = 10, P < 0. 00001). It was also noted that the highly cited journals were the PSSJ (JPS and Pediatric Surgery International), followed by the NPSSJ. (Pediatric anesthesia printarticle.asp?issn=0971-9261;year=2022;volume=27;issue=6;spage=689;epage=698;aulast=Dhua). When citations received per article (CPI) were considered, JPS (PSSJ) was followed by two NPSSJ journals (PA and Journal of Laparoscopy and advanced surgical techniques [JLAST]). In terms of mean CPIPY, two NPPSJ (PA and JLAST) were in the top followed by PSSJ (JPS) in the third place. In a bibliometric study done by Feng et al. on EA, they observed that 1/3rd of total articles on esophageal atresia (EA) were in pediatric surgery-specific journals.[9] Furthermore, they had noted that the highest citations received per article were from the articles that were published in high-impact non-pediatric surgery journals.[9] Their speculation was that the authors of original articles bearing significant research work and results on EA probably preferred to submit their results in high-impact journals with a wider audience and specialties rather than in journals directed to only the pediatric surgery community. Unlike their speculation, our findings highlight that PIH per se is a condition which is mainly managed by pediatric surgeons, in comparison to the multimodality approach in EA where the role of a pediatrician/neonatology is significant, and therefore, influential research work in EA could find a place in non-pediatric surgery specific journals also. Furthermore, one can note that the citations and the citations per article received [Table 2] in the pediatric surgery specific journals are significantly higher than that of the nonpediatric surgery journals. It seems therefore that these papers in pediatric surgery journals were superior to those of non-pediatric surgery journals. A rider to this assumption would be to understand that the higher number of articles in the PSSJ group could partly account for the skewed results in favor of PSSJ articles. The phenomena of a larger audience and wider circulation of the articles in the NPSSJ group may have a role in accruing a wholesome number of citations as compared to that of PSSJ, despite having a significantly lesser number of articles in the top-25 rankings.

A spin-off observation was that a significant proportion of articles in this list of top-cited articles studies are on a cohort of patients. It was striking to note that metanalysis and systematic reviews, which form the top rank in the pyramid of the level of evidence, are largely lacking in this list (excluding no. 14). This may be explained by the fact that it is technically difficult to design a prospective randomized controlled trial in a surgical condition in which the surgical principles are already well established. Only variations in techniques are evolving. The sample size for establishing a marked difference in outcome to compare these newer techniques would be large; moreover, multicenter studies with heterogeneity existing among the patient population can be a challenge in designing large-scale randomized controlled trials.[10] Hence, randomized studies in PIH are far and few, and therefore, these articles (metanalysis and randomized control trials) are underrepresented in our most cited 25 articles.

From our observations, it would not be wrong to state that pioneering research work in PIH has originated from institutes in the USA, followed by centers in Turkey and China. The USA has remained the dominating country in terms of the origin of medical research in various other studies[2],[11] as well as in a study done on Herniology in adults.[8] In EA and tracheoesophageal fistula, a bibliometric study was conducted recently by Feng et al. and they found that the top countries were the USA, United Kingdom, and China in terms of total research productivity.[9] Interestingly, in our review, we found Turkey in the second spot. Any variations in this order of contribution to research output are generally attributed to the geographical distribution of a disease condition, as in a study on Choledochal cyst by Friedmacher et. al. They noted that the top contributors were in the order: the USA, Japan, and China.[12] In our study despite being there no geographical preference and affinity of PIH to any population, Turkey's exceptional performance is commendable but any specific reason for this finding remains elusive.

The top-five prolific authors were listed, and Schier (n = 21) was found to be leading in all the parameters that we had considered (citations, CPI, and h-index), except CPIPY which was highest for Esposito. Despite having the lowest number of papers (n = 10) among these ranking, Escolino had the second-highest CPIPY, indicating the high quality of his papers.

The visualization maps for the country showed that the USA has the highest international collaborations followed by Italy and Germany. In terms of the institutions involved in collaborative work, the Royal Children's Hospital, Murdoch Children's Research Institute, and the University of Melbourne were the top three organizations that stand out. The co-authorship maps depict Esposito, Settimi, and Escolino as the top-three authors in terms of collaborative links. It may be noted that five out of eight authors (Schier, Esposito, Ponsky, Settimi, and Escolino amongst the top productive authors [Table 6] also feature in the co-authorship map [Figure 8]. Feng et al. in their bibliometric study on EA also noted a similar finding between collaboration and productivity. In their study, half of the best-connected authors were responsible for the most productive and most cited articles.[9] This emphasizes that collaborative research and its publication have higher chances of adding value to the paper as far as receiving higher citations is concerned and it has the potential to become a relatively more influential paper as compared to those articles which are authored by single institution only.

There are some limitations to this study that merits discussion. The citation count is a dynamic value, and hence, our analysis is akin to taking a screenshot of the ever-evolving literature. One may also note that a citation count does not reflect whether it is a citation made with positive or negative intent in a particular article.[2] It is also understandable that the chances that a particular article gets cited depend on the type of article it is; for example, meta-analyses or systematic reviews tend to gather more citations than others.[3] Also, articles published earlier gets more exposure to the scientific community and therefore have more probability of accumulating higher citations than those which are published recently. The “Web of Science” citation numbers might not be wholly representative of the true citation count as many available manuscripts may not have been included under its purview. The utilization of multiple databases can generate a higher citation number.[4] Several biases like institutional bias, self-citation, powerful person, and language bias have not been factored in this study, and these could have affected the manuscript's rankings. Nevertheless, this bibliometric analysis in PIH is the first in the field of pediatric surgery to provide a list of the top-25 cited articles dedicated to PIH. Through this study, the research areas and major academic publications pertaining to PIH were identified. This analysis of the citation count would provide a reference for quoting the most influential papers in the field of PIH in future publications.

   Conclusion Top

Articles on laparoscopic repair in PIH have been received interest among the pediatric surgery community and have been heavily cited. Following the USA, Turkey stands out as the topmost productive country in PIH. “Collaboration” formed the bridging force in PIH publications between productivity and influence on the academic community.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

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Loonen MP, Hage JJ, Kon M. Plastic surgery classics: Characteristics of 50 top-cited articles in four plastic Surgery journals since 1946. Plast Reconstr Surg 2008;121:320e-7e.  Back to cited text no. 3
Fan KS, Leung KH, Fan KH, Chan J. Top 100 most influential manuscripts in congenital abdominal pediatric surgery: A bibliometric analysis. J Indian Assoc Pediatr Surg 2021;26:6-10.  Back to cited text no. 4
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Feng X, Martynov I, Suttkus A, Lacher M, Mayer S. Publication trends and global collaborations on esophageal atresia research: A bibliometric study. Eur J Pediatr Surg 2021;31:164-71.  Back to cited text no. 9
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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