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Unilateral inguinal hernias in children: What about the opposite side?
Insights
Unilateral hernia repair in infants requires checking the other side for hidden hernias. Routine bilateral hernia repair is not recommended due to risks; herniography is a safe diagnostic tool.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Infants with unilateral hernias often have asymptomatic contralateral hernias.
- The management of unilateral inguinal hernias in infants requires careful consideration of contralateral involvement.
Purpose of the Study:
- To evaluate the necessity of bilateral exploration in infants with unilateral hernias.
- To assess the reliability of intraoperative diagnostic methods and the utility of herniography.
Main Methods:
- Retrospective analysis of 400 pediatric patients undergoing hernia repair.
- Evaluation of intraoperative diagnostic techniques (Bakes dilator).
- Assessment of herniography as a diagnostic tool for contralateral hernias.
Main Results:
- Unilateral repair without contralateral assessment is considered unjustified.
- Intraoperative methods for detecting contralateral sacs were unreliable.
- Herniography demonstrated reliability and safety in identifying contralateral hernias, reducing unnecessary explorations.
Conclusions:
- Herniography is a valuable tool for accurately diagnosing contralateral hernias in infants.
- Avoid routine bilateral herniorrhaphies due to potential risks to gonads and vas deferens.
- Selective use of herniography is recommended when contralateral exploration is uncertain.
Abstract:
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.