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Avoid contralateral inguinal laparoscopy when performing a pediatric inguinal hernia repair
Carla Ramirez, MD1, Martin Kaefer, MD2.
1Roosevelt Hospital, Guatemala City, Guatemala, 2Indiana University, Indianapolis, IN, USA.

Background:In children it has become common practice to perform contralateral inguinal laparoscopy at the time of hernia repair in order to identify an occult contralateral hernia. However, when proper endoscopic equipment is either not available or the hernia sac is too narrow to accept an endoscope, identification of a contralateral hernia can be difficult. We describe a simple technique that addresses both potential limitations. We hypothesize that simple abdominal insufflation to a pressure of 15 cm H20 is sufficient to identify a contralateral inguinal hernia. Methods:A prospective evaluation of all patients presenting with inguinal hernia was undertaken. At the time of inguinal surgery, a feeding tube was placed into the abdomen through the process vaginalis. With the patient in 30 degree Trendelenburg position the abdomen was Insufflated to 15 cm H2O. If either visual (i.e. inguinal-scrotal swelling) or palpable (i.e. crepitus) evidence of a contralateral hernia was noted, then contralateral surgical repair was undertaken. The medical records of consecutive patients undergoing hernia repair between December 2009 and December 2021 were reviewed. Laterality, ability to proceed with insufflation and follow up for later development of a contralateral hernia were recorded. Results:During this 12-year period, 406 children underwent inguinal hernia surgery. Average age at time of procedure was 4.3 years (range 0.5-11.1 years). 51 patients were excluded due to bilaterality or having had previous contralateral hernia repair. In the remaining 355 patients the processes vaginalis was of sufficient size to accept a feeding tube in 56% of cases (n=198). Twenty- nine (15%) of those who underwent insufflation exhibited contralateral evidence of a patent processes vaginalis and this was confirmed in 100% of cases upon contralateral exploration. The remaining 169 (85%) that did not demonstrate contralateral swelling or crepitus have been followed for an average of 4.7 years with only one subsequently demonstrating a contralateral hydrocele (non-communicating). Conclusions:Simple abdominal Insufflation is fast, easy, effective and highly reliable for identification of a contralateral inguinal hernia. This technique allows for patients with even small diameter hernias to be evaluated, avoids the need for laparoscopic equipment and thereby also serves to reduce surgical cost.


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