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The parental perspective regarding the contralateral inguinal region in a child with a known unilateral inguinal
George W Holcomb1, Kelly A Miller, Beverly E Chaignaud
1Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Parents prefer laparoscopic contralateral inspection for pediatric inguinal hernias primarily for convenience, not anesthesia concerns. This approach offers a less invasive option for managing potential contralateral patent processus vaginalis (CPPV).
Area of Science:
- Pediatric Surgery
- Surgical Management
- Parental Decision-Making
Background:
- The management of the contralateral inguinal region in children with unilateral inguinal hernia is a long-standing surgical debate.
- Parental perspectives on contralateral management strategies have not been previously investigated.
Purpose of the Study:
- To evaluate parental views and preferences regarding the management of the contralateral region in pediatric unilateral inguinal hernia.
- To understand parental motivations behind choosing specific surgical approaches for contralateral inguinal hernias.
Main Methods:
- Prospective study of 167 children under 10 with unilateral inguinal hernia from November 2001 to February 2003.
- Parents received information on inguinal hernia, contralateral patent processus vaginalis (CPPV) incidence (20-40%), and surgical options.
- Motivations for contralateral inspection (convenience vs. anesthesia concerns) were assessed in 113 parents.
Main Results:
- 142 parents opted for unilateral hernia repair with laparoscopic contralateral inspection and repair if needed.
- Convenience was the primary motive for contralateral inspection in 90 out of 113 parents.
- Only 21 parents expressed concerns about a second anesthesia procedure.
Conclusions:
- Parents favor laparoscopic contralateral inspection and repair for unilateral inguinal hernias, driven mainly by convenience.
- Parental preference leans towards less invasive, single-session management strategies when possible.
Purpose:
The management of the contralateral region in a child with a known inguinal hernia has been debated by surgeons for more than 50 years. However, the perspective of the child's parents has not been sought, and this study was designed to evaluate parental views on this topic.
Methods:
After IRB approval, all patients less than 10 years of age with a unilateral inguinal hernia seen by the senior surgeon were studied prospectively from November 2001 through February 2003. A study sheet was given to the parents about the nature of an inguinal hernia, the incidence of 20% to 40% of a contralateral patent processus vaginalis (CPPV), and the possible surgical options (perform repair of the unilateral inguinal hernia only, repair the unilateral inguinal hernia with contralateral exploration and repair if indicated, or unilateral inguinal hernia repair with laparoscopy through the ipsilateral hernia sac and repair of a CPPV if discovered). The parents of the last 113 patients requesting contralateral inspection were asked their motives (convenience or anesthesia concerns) regarding their decision.
Results:
One hundred sixty-seven patients comprise the study group. Twelve parents chose unilateral repair alone, 13 chose bilateral incisions with contralateral repair if a CPPV was found, and 142 chose unilateral hernia repair with laparoscopic contralateral inspection followed by repair if needed. Regarding their motives, 90 of the last 113 parents requesting contralateral inspection indicated that convenience was the primary motive. Surprisingly, only 21 exhibited concerns about their child undergoing a second anesthesia.
Conclusions:
When presented options regarding management of a unilateral inguinal hernia, parents preferred laparoscopic inspection and repair of the contralateral region, if needed, more for convenience than for concerns about a second procedure and anesthesia.
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