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Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal
1Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China.
Insights
Laparoscopic repair of pediatric inguinal hernias is linked to fewer recurrences. Closing a contralateral patent processus vaginalis (CPPV) during laparoscopy significantly lowers the risk of metachronous inguinal hernia (MIH).
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic techniques for pediatric inguinal hernia raise questions about the necessity of simultaneously closing a contralateral patent processus vaginalis (CPPV).
- Understanding the risk of metachronous inguinal hernia (MIH) in children with CPPV is crucial for surgical decision-making.
Purpose of the Study:
- To determine the incidence of metachronous inguinal hernia (MIH) in children with a contralateral patent processus vaginalis (CPPV).
- To compare the efficacy of open versus laparoscopic repair in pediatric inguinal hernias, including CPPV management.
Main Methods:
- A comparative study involving children with unilateral inguinal hernia undergoing either open or laparoscopic repair across two hospitals.
- Follow-up evaluation for MIH, with CPPV identified and closed during laparoscopic procedures.
- Statistical analysis to assess the relationship between CPPV and subsequent MIH development.
Main Results:
- Open repair had a 2.4% rate of MIH, while laparoscopic repair with CPPV closure showed a significantly lower MIH rate of 0.1%.
- Ipsilateral recurrence was less frequent after laparoscopic repair (0.2%) compared to open repair (1.0%).
- Routine closure of CPPV during laparoscopy reduced MIH, with 21 closures needed to prevent one MIH.
Conclusions:
- Laparoscopic inguinal hernia repair offers a lower recurrence rate than open repair in children.
- Simultaneous closure of CPPV during laparoscopic procedures effectively reduces the incidence of metachronous inguinal hernias.
- While effective, the routine closure of CPPV requires careful consideration of the number needed to treat to prevent one MIH.
Background:
The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV.
Methods:
Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH. The presence of CPPV was evaluated during laparoscopy and, if detected, the CPPV was closed. The relationship between CPPV and subsequent MIH was studied.
Results:
The study included children who had complete follow-up (90·0 per cent of those having open repair and 92·2 per cent of those undergoing laparoscopic repair). Of 2538 children who had open hernia repair, 62 (2·4 per cent) developed MIH (30 on the right side and 32 on the left; P = 0·015). Among 2855 children who underwent laparoscopic repair, a CPPV was identified and closed in 1469 (51·5 per cent). The rate of MIH after negative laparoscopic evaluation for CPPV was three of 2855 (0·1 per cent). There were no significant differences in the rate of CPPV between sexes and either the right or left side (P = 0·072 and P = 0·099 respectively). Ipsilateral recurrence was less frequent after laparoscopic repair: seven (0·2 per cent) versus 26 (1·0 per cent) for open repair (P < 0·001).
Conclusion:
Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH.
