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Effectiveness of preoperative ultrasonography in predicting metachronous contralateral inguinal hernia in children: a
Linlin Zhu1, Feng Chen1, Jing Xiong1
1Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China.
Insights
Ultrasonography shows limited accuracy in diagnosing contralateral persistent processus vaginalis (CPPV) in children with inguinal hernias. However, it shows promise for predicting metachronous contralateral inguinal hernia (MCIH) when strict diagnostic criteria are used.
Area of Science:
- Pediatric surgery
- Diagnostic imaging
- Hernia surgery
Background:
- Unilateral inguinal hernia is common in children.
- Contralateral persistent processus vaginalis (CPPV) and metachronous contralateral inguinal hernia (MCIH) are potential complications.
- Accurate preoperative diagnosis is crucial for appropriate management.
Purpose of the Study:
- To evaluate the efficacy of preoperative ultrasonography in predicting MCIH.
- To assess the diagnostic value of ultrasonography for CPPV in children with unilateral inguinal hernia.
Main Methods:
- A prospective study involving children with unilateral inguinal hernia.
- Preoperative ultrasonography of the contralateral groin was performed.
- Patients were managed based on ultrasound or laparoscopic findings, with a 2-year follow-up.
- Comparison with a historical control group.
Main Results:
- Ultrasonography demonstrated low accuracy (59.3%), sensitivity (21.2%), and specificity (99.2%) in detecting CPPV.
- Ultrasonography showed higher accuracy (89.3%), sensitivity (52.4%), and specificity (92.5%) in predicting MCIH.
- MCIH developed in 10 patients in the A1 group and 74 in the control group.
Conclusions:
- Preoperative ultrasonography is currently insufficient for accurate CPPV detection in pediatric inguinal hernia cases.
- Ultrasonography shows potential as a predictive tool for MCIH, particularly with stringent diagnostic criteria.
Purpose:
To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted.
Methods:
All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results.
Results:
In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively.
Conclusions:
Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.
