Incidence of Metachronous Inguinal Hernia among Children under One Year of Age in Pediatric Surgery

Background: Pediatric inguinal hernia is one of the frequent causes of childhood morbidity. Therefore, the aim of the present study was to determine the incidence of metachronous contralateral inguinal hernia in pediatric patients aged ≤ 12 months, in Northern Saudi Arabia. Methodology: In the present study, records of a series of 90 pediatric patients (aged ≤ 12 months) were presented with inguinal hernia and have subsequently undergone inguinal hernia repair. Results: About 2/30 (6.6%) with left side hernia were found with subsequent right side metachronous contralateral inguinal hernia (MCIH) occurrence. One out of the two 1/2 (50%) was found at the age of 2 months, the other one 1/2 (50%) was at the age of 6 months. The 3/54 (5.5%) with right inguinal hernia developed a contralateral hernia, of whom 2/3 (66.6%) were found at the age of 12 months, and one 1/3 (33.3%) was at the age of 2 months. Conclusion: The findings of the present study suggest that there is a relatively higher incidence of contralateral inguinal hernia if the initial presentation was on the left side, which necessitates a close follow up for those patients; however, there is not enough evidence to support routine exploration of the contralateral groin surgically.

Comparison of the Results of Contralateral Exploration in Pediatric Inguinal Hernia

Contralateral groin exploration (CGE) in children with unilateral inguinal hernia remains controversial. Between January 2002 and December 2007, 1967 pediatric patients with inguinal hernia were treated by two surgeons with different criteria of CGE (group A; boys younger than 2 years, older boys prematurely delivered, and all girls, B; birth weight lower than 2kg with inguinal hernia presentation within 6 months after birth, and suspicious physical findings) at Samsung medical center. Patient's age, sex, body weight, diagnosis, and metachronous contralateral inguinal hernia (MIH) incidence were analyzed retrospectively. Among 895 patients in group A, CGE was performed in 460 patients (66.4%) and MIH incidence was 1.7%. In group B, 31 patients (3.5%) had CGE among 1072 patients, and MIH incidence was 4.2%. The average hospital costs of group A and B were 763,956 won and 500,708 won, respectively. The CGE criteria of group B had advantage in total hospital cost. The primary site and the age at presentation had a signiticant effect on the incidence of MIH. But MIH incidence was low and the more contralateral explorations lead to increase of total costs. Therefore, routine contralateral groin exploration and surgery for a patent processus vaginalis could not be justified.