INGUINAL-HERNIA IN CHILDREN - US VERSUS EXPLORATORY SURGERY AND INTRAOPERATIVE CONTRALATERAL LAPAROSCOPY

PURPOSE: To analyze the value of ultrasound (US) in the preoperative r ecognition of clinically apparent and inapparent inguinal hernias (or patent processus vaginalis). MATERIALS AND METHODS: Two hundred sixty children (197 boys, 63 girls), in whom a clinical diagnosis of inguina l hernia (226 unilateral hernias, 34 bilateral hernias) had been made, underwent US examination with a 7.0-MHz linear-array transducer. The contralateral internal inguinal ring was evaluated by means of intraop erative laparoscopy in 141 patients. The 197 boys were grouped togethe r by age (<12 months, 12-24 months, 24-48 months, 48-72 months, and >7 2 months). RESULTS: In the 260 patients who underwent inguinal hernior rhaphy, 246 hernias (95%) were correctly diagnosed at US based on crit eria of an internal inguinal ring width greater than 4 mm in diameter or the presence of fluid or organs in the inguinal canal at rest or du ring straining. A total of 473 hernias were confirmed surgically and 4 59 (97%) hernias were correctly detected at US. A statistically signif icant difference in the mean width of the internal inguinal ring of th e five age groups was found between patients at rest and during strain ing (P <.05) in US measurement of the 197 surgically proved cases in b oys. CONCLUSION: US is a noninvasive, readily available, and highly ac curate (95%) method for evaluating the presence of inguinal hernia in children at risk, especially when the clinical findings are equivocal or normal. US can provide an objective measure in determining the advi sability of exploratory inguinal surgery in such cases.