Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic...

Laparoscopic inguinal "exploration" was undertaken in 22 consecutive pediatric patients to assess the value of this technique in detecting the presence or absence of occult inguinal hernias on the asymptomatic side of patients with unilateral disease. After a CO2 pneumoperitoneum was established using a Veress needle, a 2 mm 0 degree laparoscope was passed via a 3 mm cannula and both inguinal rings were inspected. Eleven cases (50%) had previously unsuspected bilateral disease diagnosed at laparoscopy and had bilateral inguinal hernias confirmed at exploration. Nine cases, in which the asymptomatic side was assessed as being negative at laparoscopy, were confirmed negative by open exploration. In one misdiagnosed case of bilateral hernias, no hernias were found at laparoscopy and one side had a non-communicating hydrocele at exploration. There was one failure, an infant less than 2 months of age, in whom the inguinal anatomy could not be adequately visualized at laparoscopy and a hernia was found at exploration. There were no complications. Thus, laparoscopic inguinal "exploration" was 96% accurate in this initial evaluation. The adoption of this approach to the assessment of the asymptomatic contralateral side in infants with unilateral hernias would eliminate many inguinal operations and the complications associated with unnecessarily manipulating the delicate cord structures.