Incidence of contralateral inguinal hernia: a prospective analysis
Related Experiment Video
Updated: Aug 19, 2026
Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration
Published on: February 10, 2023
L D Tackett1, C K Breuer, F I Luks
1Division of Pediatric Surgery, Brown University School of Medicine, and Hasbro Children's Hospital, Providence, RI, USA.
Insights
Routine contralateral groin exploration is not recommended for most children with unilateral inguinal hernia. However, it may be advisable for infants with incarceration or premature infants due to higher risks.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Management
Background:
- Contralateral groin exploration in pediatric unilateral inguinal hernia remains a debated topic, especially in infants.
- Current practices vary regarding routine bilateral procedures.
Purpose of the Study:
- To assess the age- and gender-stratified incidence of contralateral inguinal hernias in children initially presenting with unilateral hernias.
- To evaluate the necessity of routine bilateral inguinal exploration versus ipsilateral-only procedures.
Main Methods:
- Prospective study of 656 pediatric patients over 34 months.
- Patients with unilateral inguinal hernia received ipsilateral surgery only.
- Follow-up ranged from 6 to 40 months, with statistical analysis (chi-square) for comparisons.
Main Results:
- 16.5% of patients had synchronous bilateral hernias, with higher rates in premature infants (28.0%) and those under 2 years.
- A metachronous contralateral hernia developed in 8.8% of remaining patients.
- Higher incidence of contralateral hernias was observed in infants under 6 months (12.4%), under 2 years (10.6%), premature infants (14.8%), and those with incarcerated hernias (27.6%).
Conclusions:
- Routine contralateral inguinal exploration is not justified for the general pediatric population with unilateral inguinal hernia.
- Consideration for contralateral exploration may be warranted in cases of hernia incarceration and possibly in premature infants.
- The low incidence of contralateral hernias in most patient groups supports limiting exploration to the symptomatic side.
Background/Purpose:
Contralateral groin exploration in children with unilateral inguinal hernia is still controversial, particularly in infants. The authors have attempted to determine the age- and gender-stratified incidence of contralateral hernia and the necessity of routine bilateral procedures.
Methods:
This is a prospective study of 656 patients during a 34-month period at a single institution. Patients with unilateral hernia underwent an ipsilateral procedure only, regardless of age, gestational age, or gender. Follow-up was 6 to 40 months (mean, 25.5 months). Chi-square analysis was used for intergroup comparison (P < .05 significant).
Results:
Of 656 children, 108 (16.5%) presented with synchronous bilateral hernias. Bilateral inguinal hernia was significantly more common in premature infants (28.0%) and young children (33.8% if <6 months, 27.4% if <2 years). Of the remaining 548, a metachronous contralateral hernia developed in 48 (8.8%) at a median interval of 6 months (range, 4 days to 7 years). This incidence was 13 of 105 (12.4%) in infants less than 6 months of age, 20 of 189 (10.6%) in children less than 2 years of age, 8 of 54 (14.8%) in premature infants, 6 of 81 (7.4%) in girls, and 8 of 29 (27.6%) in children with an incarcerated hernia. In the latter group, P < .05, chi2 analysis.
Conclusion:
Routine contralateral inguinal exploration, without clinical evidence of a hernia, may be advisable in children with incarceration and possibly in premature infants. The low incidence of contralateral hernias in all other patients, regardless of gender or age, does not justify routine contralateral exploration.
