Skip to main content
SpringerLink
Log in

Incidence of pediatric metachronous contralateral inguinal hernia in children aged ≥1 year

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

The management of the contralateral asymptomatic side when a child with initial unilateral inguinal hernia undergoes herniorrhaphy continues to be controversial. Age less than 6 months at initial herniorrhaphy is considered as a high risk factor of the occurrence of metachronous contralateral inguinal hernia (MCIH). We performed herniorraphy for patients ≥1 year with initial unilateral hernia at oneday-set outpatient-surgery department without any intervention of contralateral groin. In this study, we reviewed the characteristics of development of MCIH in this condition and discuss the management strategies of MCIH.

Methods

The subjects of this study were children who were treated at our outpatient-surgery department from January 2006 to December 2006. A total of 2129 patients with initial unilateral hernia and aged ≥1 year underwent an ipsilateral herniorhhaphy only. Patients were followed up for the development of MCIH to 60 months. The Chi-square test was used for intergroup comparison, a level of P<0.05 was considered as statistically signifi cant.

Results

Among these children 1341 (63.0%) were obtained 60 months follow-up data, 1146 (85.5%) were boys and 195 (14.5%) were girls. MCIH developed in 70 (5.2%) patients, 61 were boys and 9 were girls. In 570 patients aged 12–23 months, 43 developed MCIH (7.5%); in 564 patients aged 24–59 months, 21 developed MCIH (3.7%); and in 207 patients ≥60 months, 6 patients developed MCIH (2.9%), the difference between these groups was highly significant (P=0.004). In male patients, 30 right-sided MCIHs occurred after 423 initial left-sided herniorrhaphies (7.1%) and 31 left-sided MCIHs occurred after 723 initial right-sided herniorrhaphies (4.3%), difference between these two groups was signifi cant (P=0.041). Seventy-seven percent of the MCIHs occurred within 1 year, 94% occurred within 2 years after initial herniorraphy.

Conclusions

As the overall incidence of MCIH in patients aged ≥1 year was 5.2%, routine contralateral groin exploration is not suggested. Transinguinal laparoscopy could be considered as an alternative of conventional “wait and see” policy, especially in patients less than 2 years or left-sided initial unilateral inguinal hernia. If “wait and see” policy is adopted, patients should be closely followed up for 2 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Levitt MA, Ferraraccio D, Arbesman MC, Brisseau GF, Caty MG, Glick PL. Variability of inguinal hernia surgical technique: A survey of North American pediatric surgeons. J Pediatr Surg 2002;37:745–751.

    Article  PubMed  CAS  Google Scholar 

  2. Burd RS, Heffington SH, Teague JL. The optimal approach for management of metachronous hernias in children: a decision analysis. J Pediatr Surg 2001;36:1190–1195.

    Article  PubMed  CAS  Google Scholar 

  3. Esposito C, Giurin I, Alicchio F, Farina A, Iaquinto M, Scermino S, et al. Unilateral inguinal hernia: laparoscopic or inguinal approach. Decision making strategy: a prospective study. Eur J Pediatr 2012;171:989–991.

    Article  PubMed  CAS  Google Scholar 

  4. Nataraja RM, Mahomed AA. Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern. Pediatr Surg Int 2011;27:953–961.

    Article  PubMed  Google Scholar 

  5. Nataraja RM, Mahomed AA. Metachronous contralateral pediatric inguinal hernia. Open Access Surgery 2010;3:87–90.

    Google Scholar 

  6. Jallouli M, Yaich S, Dhaou MB, Yengui H, Trigui D, Damak J, et al. Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia? Hernia 2009;13:613–615.

    Article  PubMed  CAS  Google Scholar 

  7. Steinau G, Böhm G, Vaassen P, Wenzl T, Schumpelick V. Contralateral inguinal hernia in childhood and youth: which child will develop a contralateral inguinal hernia? Hernia 2008;12:631–634.

    Article  PubMed  CAS  Google Scholar 

  8. Kalantari M, Shirgir S, Ahmadi J, Zanjani A, Soltani AE. Inguinal hernia and occurrence on the other side: a prospective analysis in Iran. Hernia 2008;13:41–43.

    Article  PubMed  Google Scholar 

  9. Manoharan S, Samarakkody U, Kulkarni M, Blakelock R, Brown S. Evidence-based change of practice in the management of unilateral inguinal hernia. J Pediatr Surg 2005;40:1163–1166.

    Article  PubMed  Google Scholar 

  10. Tackett LD, Breuer CK, Luks FI, Caldamone AA, Breuer JG, DeLuca FG, et al. Incidence of contralateral inguinal hernia: a prospective analysis. J Pediatr Surg 1999;34:684–688.

    Article  PubMed  CAS  Google Scholar 

  11. Ron O, Eaton S, Pierro A. Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children. Br J Surg 2007;94:804–811.

    Article  PubMed  CAS  Google Scholar 

  12. Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetz CA, Brandt ML. Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 1997;174:741–744.

    Article  PubMed  CAS  Google Scholar 

  13. Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006;41:980–986.

    Article  PubMed  Google Scholar 

  14. Ikeda H, Suzuki N, Takahashi A, Kuroiwa M, Sakai M, Tsuchida Y. Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally? J Pediatr Surg 2000;35:1746–1748.

    Article  PubMed  CAS  Google Scholar 

  15. Nassiri SJ. Contralateral exploration is not mandatory in unilateral inguinal hernia in children: a prospective 6-year study. Pediatr Surg Int 2002;18:470–471.

    Article  PubMed  Google Scholar 

  16. Zamakhshardy M, Ein A, Ein SH, Wales PW. Predictors of metachronous inguinal hernias in children. Pediatr Surg Int 2009;25:69–71.

    Article  PubMed  Google Scholar 

  17. Rothenberg RE, Barnett T. Bilateral herniotomy in infants and children. Surgery 1955;37:947–950.

    PubMed  CAS  Google Scholar 

  18. Sözübir S, Ekingen G, Senel U, Kahraman H, Güvenc BH. A continuous debate on contralateral processus vaginalis: evaluation technique and approach to patency. Hernia 2006;10:74–78.

    Article  PubMed  Google Scholar 

  19. Sparkman RS. Bilateral exploration in inguinal hernia in juvenile patients. Review and appraisal. Surgery 1962;51:393–406.

    PubMed  CAS  Google Scholar 

  20. Minton JP, Clatworthy HW Jr. Incidence of patency of the processus vaginalis. A study based on six hundred bilateral operations for inguinal hernia. Ohio Med 1961;57:530–532.

    PubMed  CAS  Google Scholar 

  21. Chu CC, Chou CY, Hsu TM, Yang TH, Ma CP, Cywcs S. Intraoperative laparoscopy in unilateral hernia repair to detect a contralateral patent processus vaginalis. Pediatr Surg Int 1993;8:385–388.

    Article  Google Scholar 

  22. Holcomb III GW. Diagnostic laparoscopy for congenital inguinal hernia. Surg Innov 1998;5:55–59.

    Article  Google Scholar 

  23. Wolf SA, Hopkins JW. Laparoscopic incidence of contralateral patent processus vaginalis in boys with clinical unilateral inguinal hernias. J Pediatr Surg 1994;29:1118–1121.

    Article  PubMed  CAS  Google Scholar 

  24. Saad S, Mansson J, Saad A, Goldfarb MA. Ten-year review of groin laparoscopy in 1001 pediatric patients with clinical unilateral inguinal hernia: an improved technique with transhernia multiple-channel scope. J Pediatr Surg 2011;46:1011–1014.

    Article  PubMed  Google Scholar 

  25. Lazar DA, Lee TC, Almulhim SI, Pinsky JR, Fitch M, Brandt ML. Transinguinal laparoscopic exploration for identifi cation of contralateral inguinal hernias in pediatric patients. J Pediatr Surg 2011;46:2349–2352.

    Article  PubMed  Google Scholar 

  26. Lee SL, Sydorak RM, Lau ST. Laparoscopic contralateral groin exploration: is it cost effective? J Pediatr Surg 2010;45:793–795.

    Article  PubMed  Google Scholar 

  27. Klin B, Efrati Y, Abu-Kishk I, Stolero S, Lotan G. The contribution of intraoperative transinguinal laparoscopic examination of the contralateral side to the repair of inguinal hernias in children. World J Pediatr 2010;6:119–124.

    Article  PubMed  Google Scholar 

  28. Mollen KP, Kane TD. Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side. Curr Opin Pediatr 2007;19:344–348.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jin-Hu Wang, Wei Zhang, Jin-Fa Tou, Shou-Jiang Huang, Wei-Guang Liu, Qi-Xing Xiong & Zheng-Yan Zhao

  2. Children’s Hospital, Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou, 310003, China

    Zheng-Yan Zhao

Authors
  1. Jin-Hu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin-Fa Tou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shou-Jiang Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei-Guang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qi-Xing Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zheng-Yan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zheng-Yan Zhao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, JH., Zhang, W., Tou, JF. et al. Incidence of pediatric metachronous contralateral inguinal hernia in children aged ≥1 year. World J Pediatr 8, 256–259 (2012). https://doi.org/10.1007/s12519-012-0367-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-012-0367-z

Key words

Search

Navigation