Selective use of intraoperative pneumoperitoneum for detection of contralateral inguinal hernia in high risk children: goldstein's test revisited

ABSTRACT

Contralateral exploration [CLE] in children with unilateral inguinal hernias is still controversial. Various methods have been devised to assess the presence of contralateral patent processes vaginalis in order to rationalize the conralateral exploration. This study evaluates the selective use of the intraoperative pneumoperitoneum technique in detecting the Contralateral hernia in high-risk children. A retrospective analysis of two groups of children who underwent repair of unilateral inguinal hernias was done. Analysis included three subgroups at high-risk of developing Contralateral hernia, namely, females, left side hernias, or children less than two years of age. In group I [n=126 patients], the intraoperative pneumo-peritoneum technique was not performed with the repair, in group II [n=14 patients], the test was performed using the Goldstein technique. In group I, 28 children presented with left-side hernias, two of them [7%] developed right-side hernias later on. Twelve were females, one of them [8%] developed Contralateral hernia. Another 37 patients were less than two years, two of them [5%] developed Contralateral hernia during the follow-up period. In group II, the intraoperative pneumoperitoneum technique was performed in 14 cases; all with left-sided hernia. Eight females [57%], and 7 less than two years of age [50%]. None of these showed signs of Contralateral patent processus vaginalis and accordingly no Contralateral exploration was performed. No Contralateral hernia developed during the follow up period. The difference in the incidence of Contralateral hernia between the groups was statistically insignificant [P values > 0.05]. The intraoperative induced pneumo-peritoneum is a valuable technique to detect the associated Contralateral hernias. It is simple to perform, less invasive, less time consuming and inexpensive. Selective use in high-risk children is advised