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Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant
Ralph F Staerkle1, Laura C Guglielmetti2, Isabella N Bielicki3
1Clarunis University Center for Gastrointestinal and Liver Diseases, Basel.
Insights
The overall incidence of metachronous contralateral inguinal hernias (MCIHs) in children is 6%. Risk factors for MCIH include initial left-sided hernias, female gender, and an open contralateral processus vaginalis (CPV).
Area of Science:
- Pediatric Surgery
- Hernia Repair
- Clinical Outcomes
Background:
- The necessity of contralateral exploration in pediatric unilateral inguinal hernias remains debated.
- Understanding the incidence and risk factors for metachronous contralateral inguinal hernias (MCIHs) is crucial for surgical decision-making.
Purpose of the Study:
- To determine the incidence of MCIHs in pediatric patients undergoing unilateral inguinal hernia repair.
- To identify factors associated with an increased risk of developing MCIH.
Main Methods:
- A systematic review of prospective studies published between 1947 and April 2020.
- Inclusion criteria: pediatric patients (0-19 years) with unilateral inguinal hernia repair, no contralateral exploration, and a minimum one-year follow-up.
- Databases searched: EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials.
Main Results:
- Seven studies comprising 1774 children were analyzed, revealing an overall MCIH incidence of 6%.
- Significantly higher MCIH incidence was observed in cases of initial left-sided hernias (9% vs. 3%), female patients (8% vs. 4%), and those with an open contralateral processus vaginalis (CPV) (14% vs. 3%).
- No significant differences in MCIH development were found based on follow-up duration or patient age.
Conclusions:
- The overall incidence of MCIH development in pediatric patients is 6%.
- Key risk factors for MCIH include initial left-sided inguinal hernias, female gender, and the presence of an open CPV.
- These findings can inform surgical strategies regarding contralateral exploration in pediatric inguinal hernia cases.
Background:
It is still not clear if the contralateral side should be explored in children with unilateral inguinal hernias. The primary aim of the present study was to assess the incidence of metachronous contralateral inguinal hernias (MCIHs) in the pediatric population. The second aim was to assess factors associated with increased risk of MCIH development.
Methods:
Prospective studies including patients from 0-19 years undergoing unilateral inguinal hernia repair without surgical exploration of the contralateral side between 1947 and April 2020 with a minimal follow-up of one year were searched. Searches included EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials.
Results:
Seven studies involving 1774 children (1452 boys (82%) and 322 girls (18%) were identified. Overall the incidence of MCIH was 6%. Incidence of MCIH development was significantly higher in children with initial left-sided (9%) versus right-sided (3%) hernia (OR 2.55 with 95% CI from 1.56 to 4.17; P = 0.0002), in female (8%) versus male (4%) children (OR 1.74 with 95% CI from 1.01 to 3.01; P = 0.0469) and in patients with open (14%) versus closed (3%) contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9; P = 0.0202). There was no significant difference in MCIH development depending on follow-up duration (follow-up of ≤2 years (i.e. 1-2 years): calculated MCIH incidence 5% (95% CI from 0.00 to 0.11%; 3 studies; 569 patients), follow-up of ≥3 years (i.e. 3-4 years): 6% (95% CI from 0.03 to 0.09; 3 studies, 983 patients)) or patients' age (MCIH incidence in children <1 year: 6.9%; older children: 4.5%; OR 1.87 with 95% CI from 0.97 to 3.62; P = 0.0618).
Conclusions:
Overall incidence of MCIH development is 6%. Initial left-sided hernia, female gender and open CPV are risk factors for MCIH development.
