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Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy
N Centeno-Wolf1, L Mircea1, O Sanchez1
1University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Insights
Patent processus vaginalis (PPV) is found in 9.1% of pediatric patients during laparoscopy. A small percentage of these patients later develop inguinal hernias, highlighting the importance of monitoring PPV.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Surgery
- Diagnostic Laparoscopy
Background:
- Patent processus vaginalis (PPV) is an incidental finding during pediatric laparoscopy.
- Understanding the natural history of PPV is crucial for predicting potential complications.
Purpose of the Study:
- To determine the prevalence of incidentally diagnosed PPV in children undergoing laparoscopy.
- To investigate the natural history of PPV, specifically its progression to symptomatic inguinal hernia.
Main Methods:
- Retrospective analysis of 416 children under 16 undergoing laparoscopy for non-PV related reasons (2000-2005).
- Documentation of internal inguinal rings and exclusion of patients with prior PV-related issues.
- Median follow-up of 10.5 years via phone inquiry and clinical examination.
Main Results:
- 38 out of 416 patients (9.1%) had an incidental PPV (33 unilateral, 5 bilateral).
- Four children (10.5%) with PPV later developed an ipsilateral inguinal hernia at a median age of 16.0 years.
- No children with an obliterated processus vaginalis developed a hernia.
Conclusions:
- Asymptomatic PPV is present in 9.1% of the studied pediatric population.
- A significant proportion (10.5%) of children with PPV may develop inguinal hernias later in life.
- Obliterated processus vaginalis is associated with zero hernia development, underscoring its protective nature.
Introduction:
Patent processus vaginalis (PPV) might be incidentally diagnosed during laparoscopy. The aims of this study were to determine the prevalence and the natural history of PPV, i.e. its possible development into symptomatic inguinal hernia.
Inclusion Criteria:
children <16years undergoing laparoscopy for pathologies other than processus vaginalis (PV) related, from 10/2000-10/2005.
Exclusion Criteria:
past or present history of PV-related pathologies. The internal inguinal rings were documented during laparoscopy. Follow-up was provided by phone inquiry and clinical examination if needed. Median follow-up was 10.5years (range 7.1-12.8).
Results:
416 patients were included. Median age at laparoscopy was 12.4years (range 3days-18.1years). Forty-three PPV (33 unilateral, 5 bilateral) were found in 38 patients (9.1%). Four children with PPV presented later with an ipsilateral inguinal hernia (10.5%, 95%CI [3%; 25%]), at a median age of 16.0years (range 11.8-17.3), at a median of 22.5months (range 12-50) after initial laparoscopy, as compared to no patient in the population with obliterated PV (0%, 95%CI [0%; 1%]).
Conclusion:
9.1% of the observed pediatric population showed an asymptomatic PPV, and 10.5% of these children later developed an inguinal hernia. None of the children with obliterated PV developed a hernia.
