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Contralateral inguinal hernial development and ipsilateral recurrence following unilateral hernial repair in infants
Insights
Inguinal hernia surgery in children rarely leads to a hernia on the opposite side, especially in older children. Routine exploration of the other side is not recommended due to low contralateral hernia development.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Research
Background:
- Unilateral inguinal hernias are common in infants and children.
- The development of contralateral hernias and ipsilateral recurrence after surgery are significant concerns.
Purpose of the Study:
- To evaluate the long-term frequency of contralateral inguinal hernia development.
- To assess the rate of ipsilateral recurrence following surgery for unilateral inguinal hernia in pediatric patients.
Main Methods:
- A retrospective study of 161 infants and children (0-12 years) who underwent surgery for unilateral inguinal hernia between 1961-1970.
- Patients were followed for 20-29 years, with data collected until 1990.
Main Results:
- 11.2% of males and 6.3% of females developed a contralateral inguinal hernia.
- Contralateral hernia development was significantly higher in children under seven years old (p < 0.05).
- The ipsilateral recurrence rate was 6.3% in males and 6.3% in females.
Conclusions:
- Routine contralateral inguinal exploration is not recommended for unilateral symptomatic inguinal hernias in children due to low contralateral development rates.
- The observed recurrence rate of 6.3% reflects outcomes in a general surgical setting with varied surgical experience.
Abstract:
The aim of the present study was to evaluate the frequency of contralateral hernial development and ipsilateral recurrence following surgery for unilateral inguinal hernia in infants and children. During the period 1961-1970, 161 infants and children (143 males and 18 females; 0-12 years old) underwent surgery for unilateral inguinal hernia. The patients were followed for 20-29 years (until 1990). 16/143 males (11.2%), and 1/18 females developed a contralateral inguinal hernia; the frequency among patients less than seven years old was significantly higher than the frequency among older children (16/118 > 1/43; p < 0.05). No significant difference was observed between patients primarily operated for rightsided and leftsided hernias. Four/143 boys (2.7%) experienced testicular maldescens. Recurrence after herniotomy was seen in 9/143 males (6.3%), and in 1/18 females. The low frequency of contralateral hernial development, as the risk of surgical complications, indicate that routine contralateral inguinal exploration may not be recommended while operating upon unilateral symptomatic inguinal hernias. Our recurrence rate of 6.2% may mirror the conditions in a general surgical department, where several surgeons and residents operate upon a limited number of paediatric patients.