Laparoscopic evaluation of contralateral patent processus vaginalis in children

BACKGROUND: Routine contralateral inguinal exploration following unilateral herniorrhaphy in children remains controversial. Contralateral patent processus vaginalis (PPV) incidence decreases from 80% in young infants to about 20% to 30% in the adult population. However, the incidence of a clinical hernia appearing subsequently following unilateral herniorrhaphy is 6% to 10%. METHODS: Fifty consecutive children were evaluated by diagnostic laparoscopy (DL) at the time of inguinal herniorrhaphy. RESULTS: The mean age was 3 years. Thirteen of 42 patients (31%) with a symptomatic confirmed hernia had a contralateral PPV by DL. The mean operating time was 48 minutes. The sensitivity was 98% with a specificity of 100%. No child suffered a complication due to DL. CONCLUSIONS: We found diagnostic laparoscopy in children with evidence of unilateral inguinal hernia (1) was safe, (2) revealed a 31% incidence of contralateral PPV, and (3) eliminated the need for contralateral exploration in 69%. (C) 1996 by Excerpta Medica, Inc.