538 THE USE OF DIAGNOSTIC PNEUMOPERITONEUM TO DETECT OCCULT CONTRALATERAL INGUINAL HERNIA: LARGE SINGLE-SURGEON SERIES

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2010538 THE USE OF DIAGNOSTIC PNEUMOPERITONEUM TO DETECT OCCULT CONTRALATERAL INGUINAL HERNIA: LARGE SINGLE-SURGEON SERIES Jonathan Kaye, Scott Cuda, Jonathan Kalisvaart, and Hal Scherz Jonathan KayeJonathan Kaye More articles by this author , Scott CudaScott Cuda More articles by this author , Jonathan KalisvaartJonathan Kalisvaart More articles by this author , and Hal ScherzHal Scherz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.737AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inguinal herniorrhaphy (IH) is the most common pediatric surgical procedure, with approximately 75% of cases presenting unilaterally. Prior studies have demonstrated no predilection for either side, but have established that approximately 40% of “unilateral” pediatric hernia patients have a patent contralateral processus vaginalis. Roughly half of these patients will develop an inguinal hernia. However, the questions of how to identify at the time of IH those children at risk for developing a clinically significant contralateral hernia remain matters of debate. Diagnostic pneumoperitoneum, or the so-called Goldstein test, is commonly used to identify an occult contralateral hernia. In this largest series to date, we report our single-surgeon experience with this technique and compare our findings to those published previously. METHODS Chart review was performed for patients ages 3 months-12 years undergoing unilateral IH by a single surgeon over a 15-year period. Patients without patent processus vaginalis, with thin and friable hernia sac, with prior contralateral repair or with ventriculoperitoneal shunt did not undergo diagnostic pneumoperitoneum, and were therefore excluded from analysis. In all other cases, the peritoneal cavity was insuflated to 20 mm/Hg through an 8 Fr feeding tube placed through that pocessus vaginalis. All patients with a positive Goldstein test underwent concomitant contralateral repair. Demographics, laterality, intra-op findings and recurrence were recorded for all patients. RESULTS Between January 2, 1994 and October 1, 2008, 535 patients (520 boys and 15 girls, mean age 3.0 years) underwent diagnostic pneumoperitoneum at the time of unilateral IH. 343/535 (64%) were right-sided and 192/535 (36%) were left-sided (p<0.05). Overall, 68/535 (13%) patients had a positive Goldstein test. Among those presenting with right-sided hernias, 33/343 (10%) were positive, while 35/192 (18%) of those presenting with left-sided hernias were positive (p<0.05). With mean follow-up of 7 years (range 2 months-13.5 years), there were 4 false negatives, all of whom presented with hydroceles within 2 years of their initial surgery. CONCLUSIONS Diagnostic pneumoperitoneum is a safe, efficient and reliable method of diagnosing a contralateral hernia at IH. Because its risk, time and expense are negligible, we believe that its use should be routine as it obviates an additional surgery in a handful of children. Contrary to prior studies, right-sided hernias (both apparent and occult) predominate over left-sided hernias. Atlanta, GA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e212 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Kaye More articles by this author Scott Cuda More articles by this author Jonathan Kalisvaart More articles by this author Hal Scherz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...