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Is there an increased risk of complications with laparoscopy looking for a contralateral patent processus vaginalis?
Vincent E Mortellaro1, Alessandra C Gasior, E Marty Knott
1Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
Insights
Laparoscopic contralateral exploration for unilateral inguinal hernias in children does not increase surgical site infection or recurrence risk. This approach is safe and does not elevate complication rates in pediatric hernia repair.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Unilateral congenital inguinal hernia in children often presents with an occult contralateral patent processus vaginalis (CPPV).
- Laparoscopic contralateral exploration is a common practice for evaluating CPPV.
- The impact of laparoscopy on postoperative complications like surgical site infection (SSI) remains underreported.
Purpose of the Study:
- To evaluate the incidence of surgical site infections and recurrence rates in pediatric patients undergoing unilateral inguinal hernia repair.
- To compare outcomes between patients who underwent laparoscopic contralateral exploration and those who did not.
Main Methods:
- Retrospective review of 1164 pediatric patients with unilateral inguinal hernia repair (2000-2010).
- Comparison of outcomes (SSI, recurrence) between 1010 patients with laparoscopic exploration and 154 without.
- Statistical analysis using Student's t test and chi-squared test with Yates's correction.
Main Results:
- No intraoperative complications from laparoscopy.
- 31% of patients undergoing laparoscopy had a CPPV.
- Overall SSI rate was 1.0% (10/1010) with no significant difference compared to the non-laparoscopy group (0.6%, 1/154).
- No difference in recurrence rates between groups (0.6% vs 0%).
Conclusions:
- Laparoscopic contralateral exploration for unilateral inguinal hernias in children is not associated with an increased risk of SSI.
- The procedure does not elevate the risk of recurrence.
- Contralateral exploration via laparoscopy is a safe adjunct to unilateral inguinal hernia repair in pediatric patients.
Background:
In young children with a unilateral congenital inguinal hernia, the relatively high incidence of an occult contralateral patent processus vaginalis (CPPV) has led to the practice of laparoscopic contralateral exploration. The effect on postoperative complications such as surgical site infection from performing the laparoscopy has not been previously reported.
Patients And Methods:
A retrospective review was conducted on all patients who underwent a unilateral inguinal hernia repair from January 1, 2000 to March 1, 2010. We compared those children who underwent laparoscopic evaluation of the contralateral inguinal ring with those who did not. Patient demographics and operative data outcomes were evaluated. Student's t test was used to compare continuous variables, and the chi-squared test with Yates's correction was used for discrete variables.
Results:
There were 1164 patients who underwent a unilateral inguinal hernia repair during the 10-year study period, and laparoscopy was used in 1010 patients. There were no intraoperative complications from the laparoscopy. In the group who underwent laparoscopy, the mean age was 4.0±3.6 years old, and 88% were male. At laparoscopic exploration, 315 (31%) patients were found to have a CPPV. There were 10 patients (1.0%) who developed a surgical site infection. Infection developed in the side used for laparoscopic exploration in 9 patients and in the contralateral side in 1 patient. All patients with surgical site infections were treated initially with oral antibiotics. Abscesses developed in 2 patients, requiring incision and drainage. No patient required hospital admission or reoperation. In the 154 patients who did not undergo laparoscopy, mean age was 4.3±4.4 years (P=.35), and 85.8% were male (P=.54). There was one wound infection identified in this control group (0.6%) (P=1.00). There was no difference in rate of recurrence (control group, 0%; exploration group, 0.6%; P=.72).
Conclusions:
There is minimal risk of infection or recurrence following unilateral inguinal hernia repair, and this risk is not increased with the use of contralateral exploration using laparoscopy.
