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Laparoscopic hernioplasties in children: the implication on contralateral groin exploration for unilateral inguinal
Md Toufique Ehsan1, A T L Ng, P H Y Chung
1Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
Insights
Laparoscopic surgery accurately identifies contralateral patent processus vaginalis (PPV) in children with unilateral inguinal hernias. This approach offers advantages over open surgery and suggests no age limit for contralateral exploration.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Inguinal hernias are common in children, with ongoing debate about exploring the other side for a patent processus vaginalis (PPV).
- Laparoscopic techniques allow simultaneous evaluation of the contralateral side during unilateral inguinal hernia repair.
Purpose of the Study:
- To evaluate the utility of laparoscopic hernioplasty in assessing the contralateral inguinal region in pediatric patients with unilateral inguinal hernias.
- To determine the incidence of contralateral patent processus vaginalis (PPV) in this population.
Main Methods:
- A retrospective review of 363 children with unilateral inguinal hernias undergoing laparoscopic repair between 2002 and 2008.
- Demographic data and laparoscopic findings were recorded and analyzed using statistical tests (Student t-test or chi-squared test).
Main Results:
- The overall incidence of contralateral PPV was 39.7% across 363 pediatric patients.
- No significant correlation was found between patient age and the incidence of contralateral inguinal hernia.
Conclusions:
- Laparoscopic hernioplasty provides accurate diagnosis of contralateral PPV in children, surpassing open herniotomy in diagnostic capability.
- Age should not be a limiting factor for contralateral exploration in pediatric inguinal hernia repair.
Background:
Inguinal hernias are commonly seen in the paediatric population. Controversies still exist regarding the need for contralateral groin exploration when an unilateral inguinal hernia is presented, since the true incidence of contralateral patent processus vaginalis is not known. With the advent of laparoscopic hernioplasty, the status of the contralateral side can be evaluated at the same setting. Here, we describe our experience in this issue after the introduction of laparoscopic hernioplasty in our unit.
Methods:
A retrospective review was carried out between October 2002 and January 2008. All patients presented with unilateral inguinal hernias were included. The demographics of the patients and the operative findings at laparoscopy were recorded. Statistics were performed using Student t-test or chi(2) test as appropriate and p < 0.05 was taken as statistically significant.
Results:
During the study period, 363 children were included in our study, of which there were 292 males and 71 females. 212 patients presented with right-sided hernias and 151 were left-sided. The mean age of patients at presentation was 48.8 months. The incidence of contralateral PPV overall was 39.7%. There was no decrease in incidence of having a contralateral inguinal hernia in relation to age.
Conclusion:
Laparoscopy can accurately diagnose contralateral PPV in children who undergo unilateral inguinal hernia repair and thus holds an advantage over open herniotomy. Furthermore, there should not be an age criteria for contralateral exploration for surgeons who perform open herniotomy.