Unilateral inguinal hernias in children: What about the opposite side?

The decision for or against bilateral exploration in unilateral hernias in infants is necessitated by the high incidence of obscure anatomic hernias on the opposite side. On the basis of studies done in 400 pediatric patients (mostly under 2 years of age), we believe that unilateral repair of a known hernia without ascertaining the presence of a contralateral hernia is unjustified. Because of an appreciable risk to the gonads and/or vas deferens, we do not believe routine bilateral herniorrhaphies in all infants are indicated. The attempts at an intraoperative, transperitoneal insertion of a Bakes dilator into a contralateral sac were unreliable in our hands. Herniography is a reliable, safe way to reduce the incidence of unnecessary contralateral exploration. It should be liberally used where the necessary radiologic expertise is available.