Prospective comparative assessment of ultrasonography and laparoscopy for contralateral patent processus vaginalis in inguinal hernia presented in the first year of life

Abstract

Background and purpose Contralateral inguinal exploration in children with unilateral inguinal hernia is still a controversial topic. The aim of this study was to present an evidence-based justification for contralateral inguinal exploration in our population after comparing the results of ultrasonography (US) and laparoscopy.
Methods Over a period of 3 years, 246 patients (207 boys and 39 girls) with unilateral inguinal hernia who were presented in the first year of life underwent an US using a 10MHz linear transducer. Operative transinguinal contralateral laparoscopic exploration was carried out in all of them. The results were compared prospectively for the sensitivity and specificity of US and laparoscopy.
Results Our results showed a predominant left-side incidence in boys (50.7%) and a right-side incidence in girls (69.2%). With respect to prematurity, 24.6% of boys and 30.8% of patients with left-sided hernia were found to be premature. In all, 64.6% of patients were diagnosed in the neonatal period. We considered positive patent processus vaginalis (PPV) on US when types I–III according to the criteria of Toki and colleagues were reported. Positive PPV was confirmed by US in 30.5% of patients and by laparoscopy in 85.2%. Sonographic assessment of contralateral PPV gave a sensitivity of 91.7% and a specificity of 87.7%. Of the patients, the laparoscopic exploration yielded positive results in 35.8%. The cost of a negative laparoscopy is 50$ and that of a positive laparoscopy is 100$, which on second admission costs 500$.
Conclusion As in our community there is a high incidence of consanguinity, preoperative assessment of contralateral hernia should be considered in patients who are presented in the first year of life and in premature infants. In experienced hands US is a highly sensitive tool for the diagnosis of contralateral hernia. Laparoscopic exploration is safe, rapid, and a proven method for diagnosis, even in infants. We recommend laparoscopic exploration for all patients who are presented in the first year of life in order to avoid second admission, which can lower costs significantly. 

Keywords: hernia, laparoscopy, pediatric surgery