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Laparoscopic exploration for the clinically undetected hernia in infancy and childhood
D P Geisler1, S Jegathesan, M C Parmley
1Schusterman Health Sciences Center, Department of Surgery, University of Oklahoma College of Medicine, Tulsa, 4502 E. 41st St., 74135-2512, Tulsa, OK, USA
Insights
Routine laparoscopic exploration for inguinal hernias in children is recommended due to a high incidence of contralateral patent processus vaginalis, especially in those under five. This approach avoids unnecessary open surgeries.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Hernia Repair Outcomes
Background:
- Contralateral groin exploration for pediatric inguinal hernias remains debated.
- Transinguinal laparoscopy aids in detecting patent processus vaginalis.
- The precise incidence and clinical significance of contralateral patent processus vaginalis are unclear.
Purpose of the Study:
- To determine the incidence of contralateral patent processus vaginalis in infants and children with unilateral inguinal hernias.
- To assess the relationship between contralateral patency and patient age, gender, and hernia side.
- To evaluate the utility of laparoscopic exploration in managing pediatric inguinal hernias.
Main Methods:
- A retrospective study of 358 infants and children treated for inguinal hernia between 1997 and 1999.
- Laparoscopic exploration of the contralateral side was performed.
- Data on contralateral patent processus vaginalis incidence were analyzed based on age, gender, and initial hernia side.
Main Results:
- Overall incidence of contralateral patent processus vaginalis was 33%.
- Bilateral inguinal hernias were more common in younger children (<5 years), with higher rates in boys and girls under one year.
- Hernia side did not significantly impact contralateral laparoscopic findings.
Conclusions:
- Routine laparoscopic exploration for contralateral patent processus vaginalis is warranted in pediatric unilateral inguinal hernia repair, particularly in children under five.
- Transinguinal laparoscopy can prevent unnecessary open explorations in approximately 66% of cases.
- Early detection and repair of contralateral patency are crucial for optimal surgical outcomes.
Background:
Routine contralateral groin exploration in infants and children with a clinically detected inguinal hernia is the subject of much debate. The detection of a patent processus vaginalis by transinguinal laparoscopy has proven advantageous. However, controversy remains regarding the true incidence of a contralateral patent processus vaginalis as well as which of these will actually develop into a clinically apparent hernia.
Methods:
From January 1997 through December 1999, 358 infants and children (aged 1 to 157 months, mean 32) were treated in the three University of Oklahoma teaching hospitals in Tulsa, Oklahoma, for inguinal hernia. The findings at laparoscopic exploration of the contralateral side were recorded to determine the incidence of contralateral patency as it relates to a child's age, gender, and side of the initial clinical diagnosis.
Results:
The overall incidence of a patent processus vaginalis on contralateral examination was 33% (117 of 358). All patent processus vaginalis were repaired. Bilateral inguinal hernia was significantly more common in younger patients (present in 50% if less than 1 year, 45% if less than 2 years, 37% if less than 5 years, and 15% if greater than 5 years of age; P <0.05). In boys, the incidence was 49%, 45%, and 32% in those under 1 year of age, under 2 years of age, and in total, respectively. In girls, the incidence was 59%, 50%, and 37% in those under 1 year of age, under 2 years of age, and in total, respectively. The side of the clinically detected hernia did not influence the laparoscopic findings of a contralateral hernia with 30% (50 of 169) positive findings on left inguinal exploration versus 31% (28 of 90) positive findings on right inguinal exploration.
Conclusions:
The high incidence of a contralateral patent processus vaginalis warrants routine laparoscopic exploration in infants and children undergoing unilateral inguinal hernia repair, especially those less than 5 years of age. The use of transinguinal laparoscopic explorations avoids unnecessary open exploration in 66% of infants and children undergoing inguinal hernia repair.
