Patent Contralateral Processus Vaginalis in Infants and Children: Is Herniotomy Justified?

Contralateral inguinal exploration in pediatric unilateral inguinal hernia has been an issue of debate. Controversy still exists on whether contralateral patent processus vaginalis (CPPV) is justifiable for herniotomy. This study was conducted to investigate the hypothesis that CPPV always necessitates herniotomy.

This prospective study was conducted on 200 pediatric patients aged 2-120 months old. All patients clinically diagnosed with a unilateral inguinal hernia underwent a clinical examination of both inguinoscrotal regions followed by ultrasonography to elucidate CPPV in both sides. Herniotomy was then performed on the hernia site with laparoscopic evaluation of CPPV. Contralateral herniotomy was performed in 44 patients with Chin's type III CPPV while the rest were followed-up for three years to detect the appearance of any contralateral inguinal hernia.

The current study included 158 boys and 42 girls (ratio of 3.8:1.0). Hernia was more common on the right side (n = 136) than the left side (n = 64). Bilateral herniotomy was performed on 44 patients with Chin's type III CPPV, while the remaining 156 patients underwent unilateral herniotomy. During the follow-up period, contralateral hernia appeared in 58 patients; the remaining 98 patients, proved to have CPPV did not complain of a clinical hernia during that period.

Inguinal herniotomy for CPPV seems not to be necessary in all cases. This would decrease the use of anesthesia and surgical morbidity in young infants and save hospital resources through avoidance of 
unnecessary operations.