ABSTRACT
BACKGROUND: Routine contralateral groin exploration in infants and children with a clinically detected inguinal hernia is the subject of much debate. The detection of a patent processus vaginalis by transinguinal laparoscopy has proven advantageous. However, controversy remains regarding the true incidence of a contralateral patent processus vaginalis as well as which of these will actually develop into a clinically apparent hernia. METHODS: From January 1997 through December 1999, 358 infants and children (aged 1 to 157 months, mean 32) were treated in the three University of Oklahoma teaching hospitals in Tulsa, Oklahoma, for inguinal hernia. The findings at laparoscopic exploration of the contralateral side were recorded to determine the incidence of contralateral patency as it relates to a child's age, gender, and side of the initial clinical diagnosis. RESULTS: The overall incidence of a patent processus vaginalis on contralateral examination was 33% (117 of 358). All patent processus vaginalis were repaired. Bilateral inguinal hernia was significantly more common in younger patients (present in 50% if less than 1 year, 45% if less than 2 years, 37% if less than 5 years, and 15% if greater than 5 years of age; P <0.05). In boys, the incidence was 49%, 45%, and 32% in those under 1 year of age, under 2 years of age, and in total, respectively. In girls, the incidence was 59%, 50%, and 37% in those under 1 year of age, under 2 years of age, and in total, respectively. The side of the clinically detected hernia did not influence the laparoscopic findings of a contralateral hernia with 30% (50 of 169) positive findings on left inguinal exploration versus 31% (28 of 90) positive findings on right inguinal exploration. CONCLUSIONS: The high incidence of a contralateral patent processus vaginalis warrants routine laparoscopic exploration in infants and children undergoing unilateral inguinal hernia repair, especially those less than 5 years of age. The use of transinguinal laparoscopic explorations avoids unnecessary open exploration in 66% of infants and children undergoing inguinal hernia repair.
Subject(s)
Hernia, Inguinal/diagnosis , Laparoscopy , Age Factors , Child , Child, Preschool , Female , Functional Laterality , Hernia, Inguinal/surgery , Humans , Infant , MaleABSTRACT
Previous studies reviewing the morbidity and mortality of infant inguinal hernia surgery have all been done in university hospital settings. From our community-based tertiary hospital, 100 consecutive cases on infants less than six months of age, undergoing inguinal hernia repair, were reviewed. No infants were excluded. Sixty-eight were full term and 32 were premature. A number of different variables were analyzed and none appeared to affect outcome. Infants were followed for three to five years. There were no true complications in any infant in this series, although six infants developed wound erythema that resolved spontaneously. Parents were given a questionnaire to subjectively evaluate the infant before and after surgery with 78% showing improvement.
Subject(s)
Hernia, Inguinal/surgery , Age Factors , Female , Hernia, Inguinal/diagnosis , Humans , Infant , Length of Stay , Male , Postoperative ComplicationsSubject(s)
Bacterial Infections/etiology , Burns, Chemical/therapy , Central Nervous System Diseases/etiology , Esophagus/injuries , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/prevention & control , Central Nervous System Diseases/prevention & control , Child, Preschool , Dilatation , Humans , Male , PremedicationABSTRACT
We describe a patient with agenesis of the left lung who also had a chromosome abnormality, probably representing a duplication of the distal part of the upper arm of chromosome 2. In addition to this finding, the existence of familial cases of lung agenesis indicate that further studies are required for better understanding of the genetic aspects of this condition.
