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Risk factors for metachronous contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure
Hiroki Mori1, Hiroki Ishibashi2, Noriko Yokota2
1Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. mori.hiroki@tokushima-u.ac.jp.
Insights
Low birth weight is a key predictor for metachronous contralateral inguinal hernia (MCH) after laparoscopic percutaneous extraperitoneal closure (LPEC) in pediatric patients. This finding suggests acquired factors may influence MCH development post-LPEC.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Laparoscopic percutaneous extraperitoneal closure (LPEC) is standard for pediatric inguinal hernia.
- Contralateral patent processus vaginalis (PPV) is often assessed during initial LPEC.
- Metachronous contralateral inguinal hernia (MCH) can develop even when no initial PPV is detected.
Purpose of the Study:
- To identify characteristics and predictors of MCH after unilateral LPEC in pediatric patients.
- To investigate factors associated with the development of MCH following initial LPEC.
- To understand the potential causes of MCH, differentiating between congenital and acquired factors.
Main Methods:
- Retrospective analysis of 1277 pediatric inguinal hernia cases treated with LPEC from 2005-2019.
- Comparison of 5 patients who developed MCH with 369 patients who did not develop MCH after unilateral LPEC.
- Evaluation of patient demographics (gender, age, low birth weight), initial hernia side, and contralateral internal inguinal ring classification.
Main Results:
- No significant differences were found in gender, age, initial-onset side, or contralateral internal inguinal ring classification between MCH and non-MCH groups.
- Low birth weight was significantly more prevalent in the MCH group compared to the non-MCH group.
- This suggests low birth weight is a potential risk factor for developing MCH.
Conclusions:
- Low birth weight is the sole identified predictor for contralateral onset after LPEC in pediatric inguinal hernia.
- The development of MCH after unilateral LPEC may be influenced by acquired factors, not solely congenital ones.
- Clinical consideration of acquired factors is warranted for unilateral LPEC cases, especially in low birth weight infants.
Purposes:
We use the laparoscopic percutaneous extraperitoneal closure (LPEC) method as the standard procedure for pediatric inguinal hernia. Despite judging there to be no contralateral patent processus vaginalis (PPV) at the time of the first LPEC, we experienced five cases in which metachronous contralateral inguinal hernia (MCH) developed, so we report the characteristics, including the predictors.
Methods:
For pediatric inguinal hernia, the LPEC method was used in 1277 cases from 2005 to 2019 in our department. Of these, 374 patients underwent unilateral LPEC, and we compared the 5 patients with MCH onset and the 369 without MCH onset. The items to be examined were the gender, age, presence of a low birth weight, initial-onset side, and contralateral internal inguinal ring classification.
Results:
There was no significant difference in the gender, age, initial-onset side, or contralateral internal inguinal ring classification between the two groups. Low-birth-weight infants were significantly more common among those with MCH than among those without MCH.
Conclusions:
The only predictor of a contralateral onset after LPEC for pediatric inguinal hernia was a low birth weight. Therefore, for the above-mentioned unilateral LPEC cases, the possibility of a contralateral onset after LPEC due to acquired factors rather than congenital factors should be considered.
