Long-Term Prospective Analysis Of Pediatric Unilateral Inguinal Hernias: Should Laparoscopy Or Anything Else Influence Contralateral Side Management?

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 12 Jun 2008 - 13:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

UroToday.com - A study out of Tennessee addressed the long battle between diagnostic contralateral inguinal laparoscopic explorations at the time of inguinal hernia repair. This study by Maddox and Smith was done in a prospective manner to determine if children who present with a unilateral inguinal hernia can be identified as at risk for developing a contralateral hernia. The group prospectively followed 299 patients between April 2000 and October 2004 with a unilateral inguinal hernia. Laparoscopy through the hernia sac was attempted in each child. Bilateral repair was performed in those with contralateral swelling or crepitus during laparoscopic evaluation. All other children were followed regardless of laparoscopic findings. They defined risk factors for hernia formation to include prematurity, family history and increased abdominal pressures. Clinical follow up as well as annual phone calls were performed to determine development of contralateral metachronous hernia.

The group found that 13 patients underwent initial bilateral inguinal hernia repairs at the time of diagnostic laparoscopy. Of the remaining patients, diagnostic contralateral laparoscopy revealed 127 closed rings, 48 partially open rings and 67 completely opened patent processus vaginalis.

The remaining 44 patients could not have laparoscopy performed due to a small ipsilateral inguinal hernia. A total of 222 patients were followed for a mean of 53.2 months (30.1-82.5 months). Of the 222 patients, 15 developed a metachronous contralateral inguinal hernia. When they looked at all the risk factors in comparing age, gender and laterality they found that only family history exhibited a significant risk for metachronous inguinal hernia. However, almost 3 quarters of the children with a family history never developed a metachronous inguinal hernia and almost all of the patients with a contralateral patent processus vaginalis have not developed one by the end of their study.

From this study, the group concluded that risk factors and laparoscopic findings failed to predict who would develop a metachronous contralateral inguinal hernia. Their recommendation at this time is that contralateral laparoscopic exploration should not be routinely performed since the yield is extremely low.

M.M. Maddoxa and D.P. Smith
Journal of Pediatric Urology, 2008
doi: 10.1016/j.jpurol.2007.09.003.

Reported by UroToday.com Medical Editor Pasquale Casale, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday