PREOPERATIVE SONOGRAPHY OF THE INGUINAL CANAL PREVENTS UNNECESSARY CONTRALATERAL EXPLORATION

The need for contralateral inguinal exploration in children during uni lateral inguinal hernia repair remains controversial. We questioned wh ether an elective preoperative sonographic examination of the contrala teral inguinal canal was accurate enough to prevent unnecessary explor ation of the asymptomatic side. Sonography (US) of the groins was perf ormed randomly in 200 out of 600 patients awaiting unilateral hernia r epair over a 1.5-year period during 1990-1991. The patients and their medical records were reviewed in 1994, 3-4 years following surgery. Fo ur hundred infants and children underwent unilateral inguinal hernia r epair without preoperative US, based on the clinical diagnosis (group I). Of the remaining 200, 160 (group II) had the clinical diagnosis co nfirmed by US. Forty patients with US evidence of a contralateral hern ia or hydrocele (group III) were excluded from the study. At follow-up after 3-4 years, 26 patients in group I presented with a hernia in th e opposite groin 2 weeks to 2 years following surgery. The incidence o f a subsequent contralateral hernia in patients under 1 year, 1-2 year s, and older than 2 years was 7.3%, 9.6%, and 4.5%, respectively. None of the patients in group II presented with a clinically evident herni a during the follow-up period. These findings suggest that US is a rea dily available, non-invasive, and accurate method of preoperative eval uation of the groins. Our policy of contralateral exploration based on the US findings was shown to be reliable in preventing unnecessary su rgical exploration of the unaffected inguinal canal.