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The contribution of intraoperative transinguinal laparoscopic examination of the contralateral side to the repair of inguinal hernias in children

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Abstract

Background

Bilateral inguinal hernias are relatively common in children. This fact has led to a controversy of more than 50 years concerning the necessity of bilateral surgical exploration during the repair of unilateral inguinal hernias in children. The advent of transinguinal laparoscopic visualization of the contralateral side is a turning point and a major contribution to the subject, offering the opportunity to reassess the systematic bilateral exploration and the “wait and see” policies currently in use at most services of pediatric surgery.

Data sources

The current information concerning intraoperative transinguinal laparoscopic evaluation of inguinal hernias in children was summarized in a didactic way. A MEDLINE search (PubMed) from 1995 to the present days was conducted.

Results

A patent processus vaginalis (PPV) is not equal to a future symptomatic hernia. There is still no definitive evidence on which PPVs will become a hernia (5.8% to 11.6%) and which remain clinically insignificant. Diagnostic intraoperative transinguinal laparoscopic evaluation of the contralateral side is today the most simple and accurate way to reduce the incidence of negative explorations.

Conclusion

Diagnostic intraoperative transinguinal laparoscopic evaluation of the contralateral side during pediatric inguinal hernia repair is a simple, accurate, fast, and effective method to assess the contralateral processus vaginalis, improving decision-making, reducing the number of negative explorations, and sparing the surgeon the embarrassment associated with the appearance of a metachronous hernia at a later date. It is easily learned and should be part of every pediatric surgeon’s practice.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Assaf Harofeh Medical Center affiliated to the Sackler School of Medicine, Tel-Aviv University, Zerifin, 70300, Israel

    Baruch Klin, Yigal Efrati & Gad Lotan

  2. Pediatric Division, Assaf Harofeh Medical Center affiliated to the Sackler School of Medicine, Tel-Aviv University, Zerifin, 70300, Israel

    Ibrahim Abu-Kishk

  3. Department of Anesthesiology, Assaf Harofeh Medical Center affiliated to the Sackler School of Medicine, Tel-Aviv University, Zerifin, 70300, Israel

    Sorin Stolero

  4. Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, 70300, Israel

    Gad Lotan

Authors
  1. Baruch Klin
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  2. Yigal Efrati
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  3. Ibrahim Abu-Kishk
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  4. Sorin Stolero
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  5. Gad Lotan
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Correspondence to Gad Lotan.

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Klin, B., Efrati, Y., Abu-Kishk, I. et al. The contribution of intraoperative transinguinal laparoscopic examination of the contralateral side to the repair of inguinal hernias in children. World J Pediatr 6, 119–124 (2010). https://doi.org/10.1007/s12519-010-0027-0

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  • DOI: https://doi.org/10.1007/s12519-010-0027-0

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