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The infantile inguinal hernia - a bilateral disease?
M G Schwöbel1, H Schramm, C A Gitzelmann
1Chirugische Klinik, Universitätskinderspital Zürich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
Insights
Routine contralateral exploration for unilateral inguinal hernias in infants is unnecessary. Most cases are unilateral, with only 5.7% requiring a second operation on the opposite side.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
Background:
- Controversy exists regarding routine contralateral exploration for unilateral inguinal hernias (IH) in infants.
- Historical data suggests a high incidence of contralateral hernias, influencing surgical practice.
Purpose of the Study:
- To evaluate the frequency of contralateral hernial development in infants under one year of age.
- To assess the validity of a selective surgical approach, operating only on the symptomatic side.
Main Methods:
- Retrospective review of medical records for 882 infants operated on for IH between 1984 and 1988.
- Follow-up of patients until December 1996 to identify contralateral hernial development.
Main Results:
- A second operation was needed on the contralateral side in 5.7% of cases.
- Premature male infants showed the highest incidence of contralateral hernial development (11.5%).
- The majority of infants (761/882) presented with unilateral IH.
Conclusions:
- Inguinal hernia in infants under one year is predominantly a unilateral disease.
- Routine exploration of the asymptomatic contralateral side is not routinely required for infants under one year of age.
Abstract:
Controversy continues whether exploration of the contralateral, asymptomatic side should routinely be performed since Rothenberg and Barnett stated in 1955 that a contralateral hernia is present in three out of four children presenting with a symptomatic unilateral inguinal hernia (IH). In our institution, hernia operations are performed on the symptomatic side only, the exception being male infants under 1 year of age with a left-sided IH. To verify our concept and to evaluate the frequency of contralateral hernial development, the medical records of all infants under 1 year of age operated upon between 1984 and 1988 were reviewed and the children followed through December 1996. Included in the study were 882 infants, 616 boys (70%) and 266 girls (30%); 148 (17%) were born prematurely. Seventy percent were operated upon before the end of the 3rd month of life. In 761 infants clinical signs of a unilateral hernia were present, and in 121 symptomatic hernias were found on both sides; 665 infants were operated upon unilaterally. A second operation on the opposite side was necessary in 38 cases (5.7%). The highest incidence of contralateral hernial development was found in premature boys (11.5%). We conclude that even in infants below 1 year of age, IH is usually a unilateral disease and does not require routine exploration of the asymptomatic side.