Laparoscopic diagnosis of contralateral patent processus vaginalis through the surgically opened sac in children with unilateral inguinal hernia

ABSTRACT

For more than two decades, the controversy has persisted as to what is to be done to the opposite side of an infant or child who has evidence of a unilateral inguinal hernia. Various methods have been advised for identifying the contralateral patent processus. Discussions on the subject intensified in recent years because of the use of laparoscopy to show the presence of a clinically undetectable contralateral hernia. Chu et al in 1993 and Groner et al in 1995 used a modified procedure in which the Laparoscope was introduced into the peritoneal cavity via the hernial sac to avoid a puncture wound. A random group of 53 patients with unilateral inguinal hernia in infants and children were studied to detect the presence of a patent processus vaginalis on the opposite side. The hernial sac was opened, and diagnostic laparoscopy was performed through the known hernia sac with C02 insufflation to 10 mm Hg. A 5 mm 30° telescope was used to inspect the contralateral inguinal region. A patent processus was diagnosed when an obvious opening through the internal ring was identified or if bubbles were seen on external manipulation of the scrotum and internal ring. Contralateral conventional exploration was then done in all cases of this series to confirm or disprove the findings of the laparoscope. Positive CPPV was diagnosed by laparoscopic exploration in 16 cases constituting 30.2%. On surgical exploration, 17 cases of CPPV were detected with an incidence of 32.1% CPPV. One patient with positive test proved to be negative on surgical exploration. Also two patients with negative tests proved to have CPPV on surgical exploration. It is worth mentioning that these three cases were early in the series. This constitutes a good degree of agreement between the two procedures with reasonable sensitivity [88.2%] and high specificity [97.2%] and total accuracy of laparoscopic diagnosis 94.3%. Laparoscopic evaluation of a contralateral patent processus vaginalis through the surgically opened sac in children with unilateral inguinal hernia is a safe and accurate procedure. This method helps avoid any unnecessary contralateral inguinal exploration. It can be performed without any complications