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Closure of contralateral patent processus vaginalis in laparoscopic unilateral inguinal hernia repair: Is it
Amar Shah1, Ria Sharma, Anirudh Shah
1Amardeep Multispecialty Children Hospital and Research Centre, Ahmedabad, Gujarat, India.
Insights
Closing the contralateral open ring during laparoscopic repair for unilateral inguinal hernias in children is not necessary. Monitoring asymptomatic patent processus vaginalis (PPV) is recommended, with repair only if a hernia develops.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic repair is a preferred method for pediatric inguinal hernias.
- Debate exists on closing the contralateral open internal ring in unilateral cases.
- The necessity for closure in asymptomatic contralateral patent processus vaginalis (PPV) requires evaluation.
Purpose of the Study:
- To determine the incidence of contralateral PPV in children with unilateral inguinal hernias.
- To assess the need for routine closure of asymptomatic contralateral PPV during laparoscopic repair.
- To evaluate the outcomes of leaving asymptomatic contralateral PPV untreated.
Main Methods:
- A 10-year retrospective study of 1300 children with unilateral inguinal hernias.
- Two 5-year phases: Phase 1 (contralateral PPV closure), Phase 2 (contralateral PPV left untreated).
- All laparoscopic repairs performed by a single surgeon, focusing on PPV ligation.
Main Results:
- Contralateral PPV incidence was 38% in Phase 1 and 40% in Phase 2.
- Metachronous hernia developed in only 10% of cases where contralateral PPV was left untreated.
- No significant complications reported from leaving asymptomatic contralateral PPV open.
Conclusions:
- Upfront closure of the contralateral open ring in pediatric unilateral inguinal hernia repair is unnecessary.
- Asymptomatic contralateral PPV can be safely monitored.
- Repair of the contralateral side is indicated only if a clinically significant hernia develops.
Introduction:
Laparoscopy has increasingly become a preferred method for repairing inguinal hernias in children. However, there is ongoing debate about the necessity of closing the contralateral open internal ring during laparoscopic repair of symptomatic unilateral hernias. This study aimed to determine the incidence of contralateral patent processus vaginalis (PPV) in children undergoing laparoscopic inguinal hernia repair and to evaluate whether closure of the contralateral ring is warranted in asymptomatic patients.
Patients And Methods:
This study included all children who presented to us with unilateral inguinal hernia. The parameters examined comprised age, gender, side of hernia, the incidence of contralateral PPV and complications. The study was conducted in two phases, each lasting 5 years. In the first phase, if the contralateral processus vaginalis was patent, it was closed following the repair of the symptomatic side. In the second phase, only the symptomatic side was repaired, and the contralateral processus vaginalis was left untreated if patent. All repairs were performed laparoscopically by a single surgeon. The results were analysed to assess the rationale for laparoscopic closure of asymptomatic contralateral PPV.
Results:
A total of 1300 patients with unilateral inguinal hernia without any associated pathologies were included in this 10-year study. Six hundred and fifty cases were analysed in each of the two 5-year phases. The mean age of the patients was 34 months (1 month-13 years). Of the participants, 73% were male and 27% were female. The surgical procedure involved ligating the hernia sac (PPV) at the internal ring without division. Follow-up durations varied from 6 months to 5 years, with a mean of 4.2 years. In phase 1, 247 children (38%) had a contralateral PPV (asymptomatic side), which was subsequently closed. In phase 2, 260 children (40%) had a contralateral PPV (asymptomatic side) which was left untreated. Development of a metachronous hernia was seen in only 10% of these cases where the PPV was not closed.
Conclusion:
Our results show that upfront closure of the contralateral open ring in children with unilateral inguinal hernia is unnecessary. These patients can be monitored, and the contralateral side should only be repaired if a clinically significant hernia develops.
