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Laparoscopic exploration of the contralateral groin in children: an improved technique
M M Fuenfer1, R M Pitts, K E Georgeson
1Department of Surgery, The Children's Hospital of Alabama, Birmingham, Alabama, USA.
Insights
Laparoscopic exploration of the contralateral groin (LECG) accurately identifies bilateral inguinal hernias in children, reducing unnecessary open surgeries. This minimally invasive technique is safe and effective for assessing asymptomatic groins.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Inguinal hernia repair is common in children.
- Bilateral inguinal hernias (BIH) are frequent, especially in those under 2 years.
- Contralateral groin exploration is debated due to risks and costs.
Purpose of the Study:
- To present a novel technique for laparoscopic exploration of the contralateral groin (LECG).
- To assess the internal inguinal ring and measure processus vaginalis patency in asymptomatic groins.
- To evaluate the efficacy and safety of LECG in pediatric patients.
Main Methods:
- LECG involves creating pneumoperitoneum via the operated side's hernia sac.
- A 1.2-mm laparoscope is inserted through the contralateral abdominal wall for direct visualization.
- A processus vaginalis patency depth >1.5 cm indicated bilaterality and required repair.
Main Results:
- LECG was performed in 110 children.
- The incidence of bilaterality detected by LECG was 21%.
- The technique demonstrated accuracy and had no associated complications.
Conclusions:
- LECG is a rapid and accurate method for diagnosing contralateral inguinal hernias in children.
- This laparoscopic approach offers a safer alternative to open exploration, minimizing morbidity.
- LECG effectively identifies the need for surgical repair, avoiding unnecessary procedures.
Abstract:
Repair of inguinal hernias are among the most frequently performed operative procedures in children. Bilateral inguinal hernias (BIH) are common, especially in patients under the age of 2 years, and present both synchronously and metachronously. Most pediatric surgeons perform open exploration of the contralateral groin in infants and young children with symptomatic unilateral inguinal hernias to avoid missing the potential metachronous presentation of BIH. The practice of contralateral groin exploration is controversial because of the increased cost, morbidity, and potentially serious complications associated with open groin exploration. We have developed a technique for laparoscopic exploration of the contralateral groin (LECG) to assess the internal inguinal ring in the asymptomatic groin and to measure the depth of a patent processus vaginalis. A pneumoperitoneum is produced by insufflation through a 14-gauge intravenous catheter placed into the hernia sac of the operated side. A 1.2-mm laparoscope is then passed through another 14-gauge intravenous catheter inserted through the abdominal wall of the contralateral side providing a direct, "in line" view of the internal ring. Depth of patency of >1.5 cm was considered positive and a standard operative repair was performed. In 110 children who underwent LECG the incidence of bilaterality was 21%. This technique is rapid, accurate and was associated with no complications.