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Related Experiment Videos

Diagnosing the occult contralateral inguinal hernia.

R H Koehler1

  • 1Martha's Vineyard Hospital, One Hospital Road, Oak Bluffs, MA 02557, USA. islandmd@vineyard.net

Surgical Endoscopy
|April 3, 2002
PubMed
Summary

Transabdominal diagnostic laparoscopy (TADL) accurately diagnosed occult contralateral hernias (OCH) in 13% of patients initially thought to have unilateral inguinal hernias. This method improves diagnostic accuracy for bilateral inguinal hernias during total extraperitoneal (TEP) repair.

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Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Hernia Repair

Background:

  • Total extraperitoneal (TEP) laparoscopic hernia repair reports a high incidence of bilateral inguinal hernias (up to 45%).
  • This incidence appears higher than with transabdominal laparoscopic and open repair methods.
  • Diagnostic laparoscopy can accurately identify occult contralateral hernias (OCH).

Purpose of the Study:

  • To evaluate the influence of concurrent transabdominal diagnostic laparoscopy (TADL) on planned TEP hernia repairs.
  • To assess the accuracy of TADL in diagnosing OCH during TEP procedures.
  • To determine the impact of TADL on surgical approach and patient outcomes.

Main Methods:

  • A prospective study of 100 consecutive TEP cases.

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  • All patients underwent diagnostic laparoscopy using a 5-mm scope with 15 mmHg pneumoperitoneum.
  • TEP repair was performed subsequently, with OCH diagnosed and repaired if observed.

    • Main Results:

    • Preoperative diagnosis suggested 31% bilateral hernias, but TADL confirmed 25%.
    • TADL identified 9 OCHs (13% of unilateral cases) and corrected 37% of preoperative bilateral diagnoses.
    • The false-negative rate for contralateral hernias was 36%, and the false-positive rate was 37%, with TADL altering the surgical approach in 26% of cases.

    Conclusions:

    • TADL identified OCH in 13% of patients with presumed unilateral inguinal hernias.
    • Accurate diagnosis via TADL prevents unnecessary TEP dissection and potential subsequent repairs.
    • This approach offers a solution for accurate contralateral inguinal region diagnosis during TEP hernia repair.