Abstract
Background
The indication for contralateral exploration in patients with a unilateral inguinal hernia and the implications of a contralateral patent processus vaginalis have been the subject of much debate during recent decades. The aim of this study was to investigate whether the size and side of the hernial sac on the side of presentation are predictive for the operative appearance of the processus vaginalis/hernial sac on the contralateral side.
Methods
All primary herniotomies performed by the Christchurch-based paediatric surgical service were reviewed. Patients who developed a contralateral hernia after unilateral repair were identified. In a random subset of patients who had bilateral exploration for unilateral hernias, the size of the clinical hernial sac was plotted against the size of the contralateral patent processus vaginalis/hernial sac (when present) as assessed at the time of open surgery.
Results
Overall, 2,124 unique patients underwent herniotomies in the period reviewed, and 44 (3.8%) metachronous contralateral hernias were identified. Girls were not at greater risk than boys of developing a metachronous hernia. There was a positive correlation between the size of the clincal hernial sac and the size of the contralateral processus vaginalis/hernial sac. There was no significant relationship between the original presenting side and the development of a metachronous contralateral hernia.
Conclusion
It is not possible to predict reliably which patients who present with a unilateral hernia would benefit from bilateral exploration, although the size of the hernia has a positive correlation with the size of the contralateral processus vaginalis/hernial sac. Those with “massive” hernias on the presenting side were more likely to have “large” contralateral hernial sacs, but how many of these would subsequently become symptomatic remains uncertain.
Similar content being viewed by others
References
Ein SH, Njere I, Ein A (2006) Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 41:980–986. doi:10.1016/j.jpedsurg.2006.01.020
Misra D, Hewitt G, Potts SR, Brown S, Boston VE (1994) Inguinal herniotomy in young infants, with emphasis on premature neonates. J Pediatr Surg 29:1496–1498. doi:10.1016/0022-3468(94)90154-6
Ikeda H, Suzuki N, Takahashi A, Kuroiwa M, Sakai M, Tsuchida Y (2000) Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally? J Pediatr Surg 35:1746–1748. doi:10.1053/jpsu.2000.19239
Schwobel MG, Schramm H, Gitzelmann CA (1999) The infantile inguinal hernia—a bilateral disease? Pediatr Surg Int 15:115–118. doi:10.1007/s003830050529
Surana R, Puri P (1994) Iatrogenic ascent of the testis: an under-recognized complication of inguinal hernia operation in children. Br J Urol 73:580–581. doi:10.1111/j.1464-410X.1994.tb07648.x
Tackett LD, Breuer CK, Luks FI, Caldamone AA, Breuer JG, DeLuca FG et al (1999) Incidence of contralateral inguinal hernia: a prospective analysis. J Pediatr Surg 34:684–687. doi:10.1016/S0022-3468(99)90356-1 discussion 687-8
Rajput A, Gauderer MW, Hack M (1992) Inguinal hernias in very low birth weight infants: incidence and timing of repair. J Pediatr Surg 27:1322–1324. doi:10.1016/0022-3468(92)90287-H
Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetz CA, Brandt ML (1997) Meta-analysis of the risk of metachronous hernia in infants and children. Am J Surg 174:741–744. see comment. doi:10.1016/S0002-9610(97)00182-7
Kvist E, Gyrtrup JH, Mejdahl S, Ronnebech J (1989) Outpatient orchiopexy and herniotomy in children. Acta Paediatr Scand 78:754–758. doi:10.1111/j.1651-2227.1989.tb11138.x
Pellegrin K, Bensard DD, Karrer FM, Meagher DP Jr (1996) Laparoscopic evaluation of contralateral patent processus vaginalis in children. Am J Surg 172:602–605. doi:10.1016/S0002-9610(96)00242-5 discussion 606
Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML (1998) Laparoscopic evaluation of the pediatric inguinal hernia—a meta-analysis. J Pediatr Surg 33:874–879. doi:10.1016/S0022-3468(98)90664-9
Geisler DP, Jegathesan S, Parmley MC, McGee JM, Nolen MG, Broughan TA (2001) Laparoscopic exploration for the clinically undetected hernia in infancy and childhood. Am J Surg 182:693–696. doi:10.1016/S0002-9610(01)00797-8
Wolf SA, Hopkins JW (1994) Laparoscopic incidence of contralateral patent processus vaginalis in boys with clinical unilateral inguinal hernias. J Pediatr Surg 29:1118–1120. doi:10.1016/0022-3468(94)90291-7 discussion 1120–1
Rowe MI, Copelson LW, Clatworthy HW (1969) The patent processus vaginalis and the inguinal hernia. J Pediatr Surg 4:102–107. doi:10.1016/0022-3468(69)90189-4
Jona JZ (1996) The incidence of positive contralateral inguinal exploration among preschool children—a retrospective and prospective study. J Pediatr Surg 31:656–660. doi:10.1016/S0022-3468(96)90668-5
Morgan EH, Anson BJ (1942) Anatomy of the region of inguinal hernia: IV. The internal surface of the parietal layers. Q Bull Northwest Univ Med Sch 16:20–37
van Wessem KJ, Simons MP, Plaisier PW, Lange JF (2003) The etiology of indirect inguinal hernias: congenital and/or acquired? Hernia 7:76–79. doi:10.1007/s10029-002-0108-7
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vogels, H.D.E., Bruijnen, C.J.P., Beasley, S.W. et al. The degree to which the size and side of an inguinal hernia is predictive of a hernia on the other side. Pediatr Surg Int 25, 229–233 (2009). https://doi.org/10.1007/s00383-008-2310-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-008-2310-x