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Incidental inguinal hernias on laparoscopy
Rakesh Handa1, Ravi Kale, Manmohan Harjai
1Department of Paediatric Surgery, Army Hospital (Research and Referral), A-49 New Friends Colony, New Delhi-110065, India. drrakeshhanda@gmail.com
Insights
Laparoscopic examination can identify asymptomatic patent processus vaginalis in children. A 1-cm diameter and 2-cm depth of the open internal ring indicate a need for laparoscopic herniotomy.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Contralateral inguinal hernias are common in children.
- Laparoscopic examination of the contralateral inguinal ring is used to detect hernias.
Purpose of the Study:
- To evaluate the size of the open internal ring and depth of the patent processus vaginalis.
- To determine indications for laparoscopic herniotomy.
Main Methods:
- Retrospective analysis of laparoscopic procedures in children over 2.5 years.
- Evaluation of 346 laparoscopic procedures.
Main Results:
- 47 incidental asymptomatic patent processus vaginalis found in 346 children.
- 38 contralateral hernias identified in 171 inguinal hernia cases.
Conclusions:
- A 1-cm diameter and 2-cm depth open internal ring suggests herniotomy.
- High incidence of contralateral patent processus vaginalis supports routine laparoscopic herniotomy.
Objective:
Laparoscopic examination of the contralateral inguinal ring has been advocated to exclude contralateral hernia in young children. We used the size of the open internal ring and the depth of the patent processus vaginalis as a parameter to decide whether laparoscopic herniotomy was indicated.
Methods:
Records of all laparoscopic procedures in children performed in a large tertiary care hospital over a 2.5-year period were retrospectively analysed.
Results:
Laparoscopy in 346 children revealed the presence of an incidental asymptomatic patent processus vaginalis in 47 cases. Of these, 38 were present as a contralateral hernia among 171 laparoscopies for inguinal hernias.
Conclusion:
The presence of an incidentally detected, asymptomatic but significant-sized open internal ring is not uncommon. The authors recommend that a 1-cm diameter and a 2-cm depth of open internal ring be taken as a significant indication for herniotomy. The authors also emphasize that a reported incidence of contralateral patent processus vaginalis of up to 56.2% justifies the procedure of laparoscopic herniotomy in all children.
