Groin Laparoscopy in Pediatric Patients with Clinical Unilateral Inguinal Hernia: An Improved Technique Using the Bronchoscope

Abstract

Contralateral inguinal exploration in children with unilateral inguinal hernia is still controversial. The authors report the transinguinal laparoscopic evaluation of the opposite site with the rigid bronchoscope. In 51 children (42 boys, 9 girls) with clinical unilateral inguinal hernia, under general anesthesia, the hernia sac was opened, a port was placed, and pneumoperitoneum was induced. A 30° angle rigid bronchoscope was inserted in the port, and the contralateral groin was explored laparoscopically. In difficult cases, a catheter was introduced through the working channel of the bronchoscope to detect a hernia sac. Contralateral inguinal hernia was present in 10 children (19.6%). In 3 of these 10 patients (30%), the hernia sac could not be established by simple inspection but was demonstrated by probing. There were no false positive or false negative findings. Follow-up varied from 1 to 24 months. There were no recurrences of hernia on either side. No complications were noted. Transinguinal laparoscopy with the rigid bronchoscope, in children with clinical unilateral inguinal hernia, provides a fast, safe, accurate and precise method for evaluation of the contralateral groin. The working channel of the bronchoscope allows probing of the contralateral inguinal ring and improves the outcome of the diagnostic laparoscopy. The risks of the standard laparoscopy, using a puncture wound, are avoided. The routine contralateral inguinal exploration and its complications are prevented.