The value of intraoperative laparoscopic examination of the contralateral inguinal ring during hernia repair in children

Approximately 40% of children with a clinical unilateral inguinal hernia di splay a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this p roblem is still controversial. Different strategies to identify patients wh o profit from an open contralateral exploration have been applied (diagnost ic pneumoperitoneum, herniography, ultrasound). The purpose of this study w as to evaluate the usefulness of intraoperative laparoscopy in a no-punctur e technique through the opened hernia sack. In 75 children (age 6 months to 7 years) with clinical unilateral hernia laparoscopy (5-mm Laparoscope, 30 degrees and 70 degrees), in cases of wide-open contralateral internal ingu inal ring (Type III) an open surgical exploration was performed. Twelve pat ients (17%) fulfilled the laparoscopic criteria of a Type III ring. The dia gnose was confirmed during open contralateral exploration. Seven children ( 8%) showed a patent but small processus vaginalis with a shallow internal r ing. These patients were treated conservatively. In the follow-up period (m edian 6 months) one subsequent hernia developed. There was no technical fai lure, and no associated complications were seen. The median time for lapaco scopy was 6 minutes. Intraoperative laparoscopy during unilateral hernia re pair allows the identification of patients who profit from bilateral open s urgery during the same operation with little additional operating time, and so far with no resulting complications. Application of this method may avo id a second hospitalization and operation as well as unnecessary routine bi lateral open exploration. As an additional source of information through ex cellent visualization of the abdominal cavity, this method proved helpful t o examine the incarcerated bowel after repositioning.