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Age-related probability of contralateral processus vaginalis patency in children with unilateral inguinal hernia
Nigel J Hall1, Wonyong Choi, Agostino Pierro
1Surgery Unit, Department of Paediatric Surgery, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. nigel.hall@ucl.ac.uk
Insights
The probability of a patent processus vaginalis (PPV) in infants with unilateral inguinal hernia decreases with age. This study provides age-related probabilities to guide decisions on contralateral groin exploration.
Area of Science:
- Pediatric Surgery
- Neonatal Surgery
- Surgical Outcomes
Background:
- Contralateral groin exploration for patent processus vaginalis (PPV) in unilateral inguinal hernia is debated.
- Precise, age-related data on contralateral PPV patency are needed to inform clinical practice.
Purpose of the Study:
- To determine age-related probabilities of contralateral processus vaginalis (PV) patency in infants with unilateral inguinal hernia.
- To provide evidence to guide the decision-making process for contralateral groin exploration.
Main Methods:
- Retrospective review of unilateral laparoscopic inguinal hernia repairs over five years.
- Logistic binomial regression analysis to estimate age-adjusted odds ratios and probabilities of contralateral PPV.
- Calculation of the number needed to explore (NNE) to close all contralateral PPVs.
Main Results:
- 48% of 331 infants had a contralateral PPV.
- Contralateral PPV probability decreased with increasing corrected gestational age (CGA).
- Probability of contralateral PPV was 50% at 8 months CGA, 33% at 49 months, and 25% at 72 months.
Conclusions:
- The study provides crucial data on the natural history of the processus vaginalis.
- These findings can assist surgeons in determining the necessity of contralateral groin exploration in infants with inguinal hernias.
Purpose:
Contralateral groin exploration with closure of a patent processus vaginalis (PPV) in children with a unilateral inguinal hernia remains controversial. We aimed to generate precise, age-related probabilities of patency of the contralateral processus vaginalis (PV) in infants with a unilateral inguinal hernia to guide practice.
Methods:
Retrospective review of all unilateral laparoscopic inguinal hernia repairs in 5 years to determine patency of contralateral PV. Using logistic binomial regression, age-adjusted odds ratio (OR), probability of contralateral PPV and number needed to explore (NNE) in order to close all PPVs were estimated.
Results:
Data from 331 children [262 male, median 3.8 months corrected gestational age (CGA)] were analysed; 160 (48 %) had a contralateral PPV. In the regression model, CGA is linearly related to log[OR] such that for each month increase in CGA, the log[OR] of having a contralateral PPV decreased by 0.017 ± 0.006 (mean ± SEM; p = 0.005). Gender and side of hernia had no significant effect. The probability of contralateral PPV is 50 % (NNE = 2) at 8 m CGA, 33 % (NNE = 3) at 49 m and 25 % (NNE = 4) at 72 m.
Conclusions:
These data contribute to our knowledge of the natural history of the PV and may help guide the need for contralateral groin exploration in infants with inguinal hernia.
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