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Transinguinal laparoscopic exploration for identification of contralateral inguinal hernias in pediatric patients
David A Lazar1, Timothy C Lee, Saad I Almulhim
1Michael E. DeBakey Department of Surgery,Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Transinguinal laparoscopy for contralateral groin exploration is safe and effective in pediatric inguinal hernia repair. This technique should be used in all children due to the high prevalence of contralateral hernias.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Transinguinal laparoscopy is increasingly used for contralateral groin exploration during unilateral inguinal hernia repair.
- Its application in older children remains debated.
- This study evaluates the safety and effectiveness of this approach in a large single-surgeon series.
Purpose of the Study:
- To assess the safety and effectiveness of transinguinal laparoscopy for contralateral groin exploration in pediatric patients undergoing inguinal hernia repair.
- To determine the prevalence of contralateral hernias or patent processus vaginalis (CPPV) in this population.
Main Methods:
- Retrospective review of open inguinal hernia repairs from 1997-2009 by a senior author.
- Laparoscopic exploration through the ipsilateral hernia sac to assess the contralateral groin.
- Exclusion criteria included inadequate sac or pre-diagnosed bilateral hernias.
Main Results:
- Of 453 children who underwent transinguinal laparoscopic exploration, 38% had a hernia or contralateral patent processus vaginalis (CPPV).
- In children over 8 years old, 32% showed a hernia or CPPV.
- No complications were reported due to laparoscopy.
Conclusions:
- Transinguinal laparoscopic exploration is a safe and effective procedure for pediatric inguinal hernia repair.
- Routine use in all pediatric patients is recommended due to the high incidence of contralateral hernias and CPPV.
Background:
The use of transinguinal laparoscopy for contralateral groin exploration during unilateral inguinal hernia repair has gained popularity. Controversy exists, however, regarding its use in older children. We report a large, single-surgeon series describing the safety and effectiveness of this procedure.
Methods:
A retrospective review was completed of all cases of open inguinal hernia repair from 1997 to 2009 performed by the senior author. Patients were explored laparoscopically through the ipsilateral hernia sac to assess the contralateral groin. Exclusion criteria were an inadequate sac or preoperatively diagnosed bilateral inguinal hernia.
Results:
A total of 649 children underwent open inguinal hernia repair. A preoperative diagnosis of bilateral hernia was made in 18% (n = 117), and of the 532 unilateral cases, an inadequate sac was present in 15% (n = 79). Transinguinal laparoscopic exploration was performed on the remaining 453 children. A hernia or contralateral patent processus vaginalis (CPPV) was found in 38% of children (n = 173). In children older than 8 years, 32% demonstrated a hernia or CPPV on laparoscopic exploration. No complications occurred because of laparoscopy.
Conclusion:
Transinguinal laparoscopic exploration is safe and effective and should be routinely performed in pediatric patients of all ages because of the high prevalence of contralateral hernia and CPPV.
