Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review

Area of Science:

• Pediatric Surgery
• Laparoscopic Surgery
• Hernia Repair

Background:

• Inguinal hernia repair is a common pediatric surgery, with laparoscopic approaches increasing.
• Laparoscopic techniques prompt debate on contralateral exploration necessity.
• Contralateral patent processus vaginalis and metachronous hernias influence treatment decisions.

Purpose of the Study:

• To evaluate the necessity of contralateral exploration during pediatric laparoscopic inguinal hernia repair.
• To determine the efficacy of prophylactic closure of contralateral patent processus vaginalis.

Main Methods:

• Systematic review of MEDLINE, Web of Science, and Scopus databases (searched September 2017).
• Included studies published since January 2012, involving patients under 18 with unilateral inguinal hernia undergoing laparoscopic evaluation.
• Excluded studies using hernioscopy; followed PRISMA criteria.

Main Results:

• 32 reports with 19,188 pediatric patients were analyzed.
• Contralateral open processus vaginalis was found in 38.5% of cases during laparoscopic repair.
• Prophylactic closure reduced metachronous hernias by 5.7% (risk difference), with 10 vs. 286 cases in laparoscopic vs. open repair comparison.

Conclusions:

• Prophylactic closure of contralateral patent processus vaginalis decreases metachronous inguinal hernias.
• Approximately 18 procedures are required to prevent one metachronous inguinal hernia.
• Decision for prophylactic closure should consider individual patient circumstances.