Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia

Zhao, Jie; Chen, Y; Lin, Jiangtao; Jin, Yue; Hu, Yang; Wang, F; Zhong, Hongji; Zhu, Jinhui

doi:10.1002/bjs.10302

Cited by 26 publications

(13 citation statements)

References 16 publications

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“…[15] A study compared metachronous inguinal hernia (MIH) incidence after both open and laparoscopic repair and reported that MIH occurred for 0.1% of patients that underwent laparoscopic repair where MIH occurred for 2.4% for those operated on through the classical open repair. [24] The authors concluded that CPPV repair in laparoscopy reduced the rate of subsequent of MIH however, 21 CPPV needed to be closed to prevent one MIH developing. [24] Another study also compared the incidence of MIH following open and laparoscopic hernia repair reported that following open repair, the incidence was 11.9%, whereas 0% of patient operated on laparoscopically developed MIH.…”

Section: Discussionmentioning

confidence: 99%

“…[24] The authors concluded that CPPV repair in laparoscopy reduced the rate of subsequent of MIH however, 21 CPPV needed to be closed to prevent one MIH developing. [24] Another study also compared the incidence of MIH following open and laparoscopic hernia repair reported that following open repair, the incidence was 11.9%, whereas 0% of patient operated on laparoscopically developed MIH. [25] Moreover, in a large series of more than 1000 patients, all of which were operated on laparoscopically, a very small MIH rate of 0.22% was reported.…”

Section: Discussionmentioning

confidence: 99%

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Our Laparoscopic Surgical technique and experience in treating pediatric inguinal hernia over the past decade

Alshammari

Sica

Talon

et al. 2020

J Indian Assoc Pediatr Surg

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Background:Over the past decade, laparoscopic hernia repair was the most performed operation in our department. Equally, it compromises 15% of all pediatric operations performed. We aim, in this study, to review all the cases performed and extrapolate important information like reoccurrences, the incidence of metachronous inguinal hernia, complications amongst other information.Material and Methods:All patients under the age of 18 whom underwent elective laparoscopic hernia repair between 03/01/2007 till the 18/05/2016 were included in our study. We recorded important clinical features and studied their post-operative follow up. Equally reoccurrences, the incidence of metachronous inguinal hernia, complications and other parameters were recorded and studied.Results:A total of 916 patients were operated on during the defined study period. There was a 0.17% reoccurrence rate and a 0.46% incidence of metachronous inguinal hernia. Equally a contralateral patent processus vaginalis was diagnosed and closed in 17.10%. There were no postoperative complications and we had a 0% postoperative hydrocele rate.Conclusion:Laparoscopic hernia repair is safe and carries all the benefits of minimally invasive surgery. We recommend that it is offered to patients and would like to refute previously claimed reports that it carries a higher reoccurrence rate or takes a long time to perform. Our reoccurrence rate of 0.17% is actually lower than many published reoccurrence rates after open repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Our Laparoscopic Surgical technique and experience in treating pediatric inguinal hernia over the past decade

Alshammari

Sica

Talon

et al. 2020

J Indian Assoc Pediatr Surg

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“…Laparoscopic hernia repair (LHR) can confirm the presence of contralateral patent processus vaginalis (CPPV). However, the incidence of CPPV evaluated by laparoscopy is 20–51.5%, which is much higher than the natural incidence of contralateral inguinal hernia (CIH) or MIH( 4 , 5 ). Ultrasonography is a safe and non-invasive method which helps to diagnose inguinal hernia and detect the presence of CPPV ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 93%

Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

Huang

Yang

et al. 2018

Front. Pediatr.

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Background/purpose: Thickening of the spermatic cord is a clinical sign of an inguinal hernia. We therefore tested whether pre-operative spermatic cord ultrasonography could reduce the incidence of metachronous inguinal hernia (MIH).Methods: Boys under 2 years old with an initial unilateral inguinal hernia were enrolled in this study. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, these patients underwent contralateral groin exploration. Age at initial operation, weight, initial operation side, the sonographic width of the spermatic cord, the operative findings and presence of MIH were recorded, and the relationship among them was studied. Boys in the US group underwent an open herniorrhaphy with pre-operative ultrasound examination; the non-US group included boys who did not undergo a pre-operative ultrasound examination. A receiver operator curve (ROC) analysis was performed to evaluated predictive value of the sonographic width of the spermatic cord for contralateral hernia.Results: A total of 24 months' follow-up data were obtained from 1,793 boys (US group 1,162, non-US group 631). In the US group, the width of the hernia-sided spermatic cord (0.75 ± 0.18 cm) was larger than the normal side (0.37 ± 0.05 cm, P < 0.001). And the width of normal side spermatic cord had no significant difference between the groups regarding other factors such as age and weight. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, the corresponding incidence of CIH was 86.4% (57/66). The width of the spermatic cord predicted the presence of contralateral hernia with ROC area under the curve = 0.943 (95% CI = 0.919–0.966). The total incidence of MIH was 4.1% (74/1793). The incidence of MIH in the US group was 2.2% (25/1162) much lower than 7.8% (49/631) in the non-US group (P < 0.001). If the width of the asymptomatic-sided spermatic cord was 0.5 cm and 0.54 cm, the corresponding sensitivity was 0.682 and 0.294, respectively, the corresponding specificity was 0.991 and 1.000, respectively.Conclusion: If the width of the asymptomatic-sided spermatic cord of boys with initial unilateral inguinal hernia sonographic width was ≥0.5 cm, contralateral groin exploration was recommended, and it help to reduce the incidence of MIH.

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“…A total of 16 studies compared the incidence of metachronous hernia between the LHRE and OHR groups, and 15 of them with a total of 14,416 patients (5207 patients in the LHRE group and 9209 patients in the OHR group) with the diagnosis of unilateral inguinal hernia who received operation were assessed [21,[23][24][25][26][27]29,32,33,36,37,[40][41][42][43]. The pooled result indicated that LHRE resulted in a considerably lower incidence of metachronous hernia compared with OHR (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001; I 2 = 4%; Figure 2).…”

Section: Metachronous Herniamentioning

confidence: 99%

“…A total of 26 studies compared the incidence of ipsilateral recurrence hernia between the LHRE and OHR groups, and the data of 25 of them covered a total of 24,430 patients (12,626 patients in the LHRE group and 11,777 patients in the OHR group) were assessed [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][43]. The incidence of ipsilateral recurrence hernia did not differ between the LHRE and OHR groups (RR: 0.97, 95% CI: 0.59 to 1.60; p = 0.91; I 2 = 44%; Figure 3).…”

Section: Ipsilateral Recurrence Herniamentioning

confidence: 99%

Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

Huang

Cheng

Hou

et al. 2022

JCM

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Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.

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Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia

Abstract: Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH.

Cited by 26 publications

References 16 publications

Our Laparoscopic Surgical technique and experience in treating pediatric inguinal hernia over the past decade

Our Laparoscopic Surgical technique and experience in treating pediatric inguinal hernia over the past decade

Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

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