An Analysis of the Utility of Pelvoscopic Exploration during Unilateral Inguinal Hernia Repair with Regards to Patient Specific Variables
Teressa A. Duong, BS, Carmen Tong, DO, Sooryan Rajendran, BS, Vincent Mortellaro, MD, David B. Joseph, MD, Stacy T. Tanaka, MD, David M. Kitchens, MD.
University of Alabama at Birmingham, Birmingham, AL, USA.
Introduction: Inguinal hernia repair is one of the most common pediatric surgical procedures. Optimal management of the contralateral side at the time of unilateral inguinal hernia repair (UIHR) remains the subject of debate in current literature. Transinguinal laparoscopic evaluation or pelvoscopy provides a minimally invasive method for exploration of the contralateral inguinal ring. In this study, we hypothesized that a history of prematurity and age less than 3 years old would be predictive of contralateral patent processus vaginalis (CPPV).
Methods: After obtaining IRB approval, we performed a retrospective chart review on every male patient who received a UIHR between September 2015 and May 2020. Patients under 5 years old were offered pelvoscopy during UIHR based on surgeon preference. Variables including but not limited to age, history of prematurity, hernia laterality, and metachronous inguinal hernia (MIH) development were recorded from preoperative and postoperative notes, operative notes, and anesthesia records. Primary outcome was absence or presence of CPPV on pelvoscopy. Statistical analysis was performed using proportion z-test on SPSS.
Results: There was a total of 497 patients who received an UIHR and 178 pelvoscopies were performed. Out of the patients who underwent pelvoscopy, 17 CPPVs were identified. All patients who had a CPPV were under 3 years old (p ≤ 0.001). There were 104 patients with a history of prematurity. Patients who had a history of prematurity were more likely to undergo pelvoscopy (p < 0.001) but were not more likely to have a CPPV (p = 0.35). Eight (15%) left-sided hernias had CPPV while 9 (7%) presented as right sided hernias (p ≤ 0.001; Table 1). Out of 13 metachronous inguinal hernias (MIHs), 4 MIHs developed in patients who received UIHR with pelvoscopy, giving pelvoscopy screening a 19% false negative rate. For UIHR patients undergoing pelvoscopy, 6.5 need to be screened to identify one right sided CPPV and 14 need to be screened to identify one left sided CPPV.
Conclusion: A history of prematurity is not a significant predictive factor in pelvoscopic results and MIH development. Patients under the age of 3 years old with initial left sided hernia presentation may be more likely to have a CPPV, and thus benefit from pelvoscopic exploration during UIHR. Future prospective studies can help determine whether pelvoscopy should be tailored to a specific subset of pediatric inguinal hernia patients.
Table 1. Patient Specific Variables and Pelvoscopic Results
| Total cohort (n = 497) | Pelvoscopy cohort(n = 178) | CPPV(n = 17) | p-value | |
| Prematurity | 104 (20.9%) | 55 (35.3%) | 7 (41.2%) | 0.35 |
| Gender Male Female | 486 (97.8%)11 (2.2%) | 176 (98.9%)2 (1.1%) | 17 0 | 0.528 |
| Age at time of Operation < 3 years old ≥ 3 years old | 273 (54.9%)224 (45.1%) | 128 (71.9%)50 (28.1%) | 170 | ≤ 0.001† |
| Initial Presentation Right sided Left sided | 322 (64.8%)175 (35.2%) | 118 (66.3%)52 (29.2%) | 9 (15)8 (7%) | ≤ 0.001†0.310.306 |
† included for significant p-values (p < 0.05).
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