Metachronous inguinal hernias in children

Abstract

Introduction: Hernia developing in the contralateral groin in children presenting with unilateral inguinal hernia is a recognized problem. There is no consensus regarding the need for exploration of the contralateral groin in children presenting with a unilateral hernia. Objectives: To study the incidence of metachronous inguinal hernia and to assess the justifiability of not exploring the contralateral groin. Methods: All children operated for unilateral inguinal hernia in our unit between April 1995 and April 1998 were asked to present themselves for review in April 2000. Results: Hundred and forty six of the 247 children operated turned up for review. There were 96 (66%) boys and 50 (34%) girls. The ages ranged from 54 days to 11 years. Eight of the 50 girls (16%) and 14 of the 96 boys (15%) developed metachronous inguinal hernias. Metachronous hernias developed in 5 of the 42 children (12%) who had their first operation at the age of 2 years or earlier. Conclusion: Routine exploration of the contralateral groin of all children cannot be justified as only 15% developed metachronous hernias. Some surgeons are selective and explore the contralateral groins of all girls and in boys under 2 years. This policy also could not be justified as the incidence of metachronous hernia was equal in both sexes and was not higher in children of 2 years or younger. We recommend exploring the symptomatic groin only.