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Occurrence of contralateral inguinal hernia in children following unilateral inguinal herniotomy
1Paediatric Surgery Unit, Department of Surgery, Muhimbili University College of Health Sciences, PO Box 65451, Dar es Salaam, Tanzania.
Insights
Routine contralateral exploration is not necessary for infants and children with unilateral inguinal hernia. The risk of developing a contralateral hernia after surgery is not significantly high, except in cases of left-sided hernias.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Unilateral inguinal hernia is common in infants and children.
- The decision for contralateral exploration during herniotomy is debated.
- Understanding contralateral hernia occurrence is crucial for surgical management.
Purpose of the Study:
- To determine the necessity of simultaneous contralateral exploration in pediatric unilateral inguinal hernia.
- To assess the incidence of contralateral inguinal hernia after unilateral herniotomy.
Main Methods:
- Retrospective study of 732 children undergoing unilateral inguinal herniotomy.
- Data collected from Muhimbili National Hospital Paediatric surgical ward.
- Follow-up ranged from one to thirteen years.
Main Results:
- 25 children (3.4%) developed contralateral inguinal hernias 2-76 months post-surgery.
- Contralateral hernia occurrence was not significantly higher in girls or children over 12 months.
- A statistically significant higher risk of contralateral hernia was observed in children with initial left-sided hernias (6.7%).
Conclusions:
- Routine contralateral exploration is not justified in infants and children with unilateral inguinal hernia.
- Herniotomy should be performed only when clinical evidence of contralateral hernia is present.
- While left-sided hernias show a higher risk, routine right-sided exploration is not recommended due to overall low frequency.
Objective:
To review the occurrence of contralateral inguinal hernia in infants and children who presented with unilateral inguinal hernia and underwent herniotomy in order to establish whether simultaneous contralateral exploration is a necessity in our environment.
Design:
A retrospective study.
Setting:
Muhimbili National Hospital Paediatric surgical ward.
Subjects:
Seven hundred and thirty two children.
Results:
Twenty five infants and children developed an inguinal hernia on the contralateral side 2-76 months after herniotomy. Follow-up period was one to thirteen years. Six hundred and seventy one were boys and sixty one girls (M:F = 11:1). Right side presentation was seen in two-thirds of the children. Subsequent contralateral hernia occurrence was more common in girls (4.9%) and slightly higher in children above 12 months of age (3.5%) but these comparisons were not significant (p values were 0.45 and 0.89 and R.R. values were 0.97 and 0.67 respectively). Subsequent development of contra lateral hernia in children with left-sided hernia was high (6.7%) and this was statistically significant (p = 0.002, R.R. = 3.38).
Conclusion:
The risk of occurrence of contra-lateral inguinal hernia following unilateral inguinal herniotomy is not significantly excessive when compared by age or sex implying that routine exploration on the contralateral side in infants and children clinically presenting with unilateral inguinal hernia is not justified and we recommend herniotomy only when there is adequate clinical evidence of an inguinal hernia. Despite the significant risk of developing a contralateral hernia in children with left-sided hernia, the authors do not recommend routine right-sided exploration as the frequency is not high.
