Laparoscopic Evaluation of the Asymptomatic Groin in Children at Herniorrhaphy

Abstract

The role of contralateral exploration in pediatric unilateral inguinal hernia repair remains controversial. The purposes of this study were to determine the sensitivity, specificity, and accuracy of the Goldstein test and of laparoscopic contralateral groin evaluation, and to ascertain the incidence of bilateral patent processus vaginalis (PPV). Data on all patients who underwent herniorrhaphy by a single pediatric surgeon over a 3-year period were collected prospectively. During repair of the symptomatic side, the Goldstein test and contralateral inguinal laparoscopic visualization were performed through the hernia sac prior to sac ligation. Length of follow-up ranged from 6 months to 3 ½ years. Data were collected over a 3-year period on 240 consecutive patients under the age of 15 years. Ninety-four cases were excluded from laparoscopic evaluation because of the presence of a known contralateral hernia, inability to introduce the laparoscope through the hernia sac, the presence of a friable sac, or planned contralateral exploration. In 146 patients, the sensitivity, specificity, and accuracy of the Goldstein test for detecting a contralateral PPV were 35%, 100%, and 75%, respectively, and 98%, 100%, and 99% for laparoscopy. There were no complications attributable to insufflation or to laparoscopy. Bilateral inguinal hernias or contralateral PPV were present in 97 of 240 (40%) of the total group, in 13 of 19 (68%) girls under 1 year of age, and in 39 of 77 (51%) boys under 1 year of age. Laparoscopic evaluation of the asymptomatic inguinal region via the involved hernia sac is safe, is considerably more accurate than the Goldstein test, and should be considered in all pediatric patients undergoing repair of a unilateral inguinal hernia.