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Intraoperative diagnostic pneumoperitoneum (Goldstein test) in the infant and child with unilateral inguinal hernia
D P Christenberry1, R W Powell
1Division of Pediatric Surgery, University of South Alabama Medical Center, Mobile 36617.
Insights
The Goldstein test accurately identifies contralateral hernia sacs in pediatric patients with unilateral hydroceles. This safe and economical test showed high accuracy with no false negatives.
Area of Science:
- Pediatric Surgery
- Urology
- Surgical Diagnostics
Background:
- Unilateral groin hernias in children often require assessment for contralateral involvement.
- Management strategies for pediatric inguinal hernias vary.
- Accurate diagnosis of contralateral hernia sacs is crucial for appropriate surgical planning.
Purpose of the Study:
- To evaluate the efficacy and safety of the Goldstein test in detecting contralateral hernia sacs.
- To assess the accuracy of the Goldstein test in pediatric patients undergoing hydrocele repair.
- To provide data supporting the Goldstein test as a diagnostic tool for pediatric inguinal hernias.
Main Methods:
- Prospective study of 191 infants and children undergoing operative repair for hydroceles.
- The Goldstein test was performed on 131 patients by insufflating air into the peritoneal cavity via a catheter.
- Palpation for crepitance in the contralateral groin and scrotum indicated a positive test result.
Main Results:
- The Goldstein test was positive in 38 (29%) and negative in 93 (71%) of 131 patients.
- The test demonstrated high accuracy with one false-positive (2%) and no false-negative results.
- Reasons for not performing the test included technical issues, shunts, prior surgery, bilateral hernias, and patient age.
Conclusions:
- The Goldstein test is a safe, economical, rapid, and accurate method for identifying contralateral hernia sacs in pediatric patients.
- This diagnostic approach offers a humane alternative for managing unilateral groin hernias.
- The study supports the routine use of the Goldstein test in the evaluation of pediatric hydroceles and hernias.
Abstract:
Over a 3 year period, 191 infants and children underwent operative repair of inguinal or communicating hydroceles or both. Of these patients, 131 underwent the Goldstein test to determine the presence or absence of a contralateral hernia sac. The Goldstein test was performed by introducing a soft rubber catheter through the hernia sac into the abdominal cavity and distending the peritoneal cavity with air. The contralateral groin and, in males, the scrotum were then palpated for crepitance. The presence of crepitance constituted a positive test result. Of the 131 tests performed, the results were positive in 38 (29 percent) and negative in 93 (71 percent). There was one false-positive test result (2 percent) and no false-negative results. The test was not performed in 60 patients because of technical problems in passing the catheter (22 percent), presence of a ventriculoperitoneal shunt (2 percent), previous contralateral herniorrhaphy (1.6 percent), presentation with bilateral hernias (26 percent), and patient age of 12 years (1 percent). Continued differences in approaches to the management of pediatric patients who present with unilateral groin hernias prompted this study. We believe that the Goldstein test represents a safe, economical, rapid, accurate, and humane approach to this common problem.