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Contralateral groin exploration is not justified in infants with a unilateral inguinal hernia
A Ballantyne1, G Jawaheer, F D Munro
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
Insights
Routine contralateral groin exploration is not justified in infants undergoing unilateral inguinal herniotomy. A study found a low incidence of subsequent contralateral hernia development, suggesting selective exploration may be more appropriate.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Management
Background:
- Contralateral groin exploration is common in infants with unilateral inguinal hernia due to high processus vaginalis patency rates.
- Existing data lacks specific information on the risk of contralateral hernia development in infants after unilateral inguinal herniotomy.
Purpose of the Study:
- To determine the incidence of contralateral inguinal hernia in infants (under 1 year) following a unilateral inguinal herniotomy.
Main Methods:
- Retrospective study of 181 infants who underwent unilateral inguinal herniotomy between 1986 and 1991.
- Follow-up ranged from 5 to 10 years to monitor for contralateral hernia or hydrocele development.
Main Results:
- A contralateral hernia or hydrocele developed in 7.7% of infants (14 out of 181).
- No incarcerated hernias were observed.
- Gestational age, sex, and hernia side did not impact the incidence of contralateral hernia development.
Conclusions:
- The low incidence of contralateral hernia development in infants after unilateral inguinal herniotomy does not support routine contralateral groin exploration.
- Selective or watchful waiting approaches may be considered for contralateral groin management.
Background:
In children undergoing a unilateral inguinal herniotomy, the contralateral groin is often explored on the basis of a high incidence of patency of the processus vaginalis. The patency rate is highest in infants but there are no data on the subsequent risk of contralateral hernia development purely in this population. This was a study of the incidence of contralateral inguinal hernia following unilateral inguinal herniotomy in infancy (aged less than 1 year).
Methods:
All infants who underwent a unilateral inguinal herniotomy between January 1986 and December 1991 were studied retrospectively.
Results:
One hundred and eighty-one infants (165 boys and 16 girls) were studied. Median gestational age was 37 (range 25-42) weeks and median age at operation was 87 (range 1-365) days. The herniotomy was right sided in 82.9 per cent of infants. Follow-up ranged from 5 to 10 years. A contralateral hernia/hydrocele developed in 14 infants (7.7 per cent). None of the hernias was incarcerated. Median time from operation to occurrence of the contralateral hernia was 18 (2-67) months. Gestational age, sex and the side of the hernia did not influence the incidence of contralateral hernia development.
Conclusion:
The low incidence of contralateral hernia development in infants undergoing a unilateral inguinal herniotomy does not justify routine contralateral groin exploration.