A continuous debate on contralateral processus vaginalis: evaluation technique and approach to patency

Abstract

We present our experience with the transinguinal diagnostic laparoscopy and discuss its efficacy in evaluating the contralateral side in unilateral inguinal hernias. The possible influence of the initial side of hernia, age and gender on recognized bilateralism were also evaluated in two study groups (diagnostic laparoscopy vs clinical diagnosis). In this retrospective study, we evaluated 36 bilateral, 158 left-sided and 303 right-sided consecutive inguinal hernia cases. A total of 211 out of 461 unilateral cases underwent hernia repair and transinguinal laparoscopic evaluation of the contralateral side. Complications and difficulties of the technique, the mean duration of laparoscopy and operative times were additionally analyzed from operation charts. In this study, bilateralism was determined by transinguinal laparoscopy in Group 1 (children with a contralateral patent processus vaginalis) and clinically in Group 2 those who had a metachronous hernia. The patients were also analyzed according to the side of the inguinal hernia, age and gender in both groups. We found an overall positive contralateral patency in 41 cases (19.4%). We failed to perform a successful diagnostic laparoscopy in six cases (2.7%). No anesthetic or surgical complications were noted. Transinguinal laparoscopy did not add any considerable time to the mean operation time. The incidence of bilateralism in Group 1 was higher in girls than boys. Clinically detected bilateralism was significantly higher in 0-6 month age group and contralateral patency detected via laparoscopy was high in all other age groups. We may conclude that transinguinal diagnostic laparoscopy is a feasible technique in children. We advocate its use as a tool with minimal complication risk even in the hands of novice.

Laparoscopic contralateral groin exploration: is it cost effective?

“…Finally, LCGE also minimizes the risk of presenting with an incarcerated contralateral inguinal hernia and its associated morbidity. The disadvantage of performing a LCGE is that not all CPPV identified will develop into a clinical hernia [5], thus exposing children to unnecessary procedures. At this time, there is no way of predicting which patients with a CPPV will go on to develop a clinically significant hernia.…”

Unexpected Metachronous Hernia Development in Children Following Laparoscopic Unilateral Hernia Repair with Negative Evaluation for Contralateral Patent Processus Vaginalis

“…7,15,16 Over the last decade the accumulating evidence has unquestionably supported transinguinal laparoscopy as the diagnostic tool of choice to investigate CPPV during open inguinal hernia repair. 4,9,[17][18][19][20] In recent years laparoscopic hernia repair in children has gained increasing popularity among pediatric surgeons, and different techniques have been described. 13,21-26 CPPV evaluation by transumbilical laparoscopy has then become a routine in children who undergo laparoscopic repair for clinically apparent unilateral hernia.…”

Laparoscopic repair on asymptomatic contralateral patent processus vaginalis in children with unilateral inguinal hernia: A centre experience and review of the literature

“…A patent processus vaginalis is not equivalent to a clinical hernia. 10 The reported incidence of symptomatic contralateral hernia development after conventional unilateral herniotomy was 3.4% to 29% [6][7][8][9][10][11][12][13][14][15][16] (Table 1). From local unpublished data of 252 patients from our institution, 20.6% of children developed contralateral hernia after unilateral herniotomy in a median follow-up period of 32 months.…”

“…From the literature worldwide, the reported incidence of symptomatic contralateral hernia development after conventional unilateral herniotomy was 3.4-29%. [5][6][7][8][9][10][11][12][13][14][15][16] The management of such asymptomatic contralateral groins in these children, however, has been debated for more than 50 years.…”