Contralateral transinguinal laparoscopic assessment in unilateral inguinalhernia.

Background. - Indication for surgical exploration of the contralateral groi n during unilateral hernioraphy in children is the subject of a worldwide d ebate. Routine exploration based on the likelihood of a patent processus va ginalis (PV) according to age, gender or side to some extent leads to unnec essary procedures, while routine abstention may leave a peritoneal sac, lik ely to later induce a symptomatic hernia about 10% of cases. Methods and patients. - One hundred and twenty-five children aged from 1 mo nth to 15 years underwent transinguinal laparoscopic assessment of the cont ralateral groin, using a 3 mm trocar and a 70 degrees telescope gently intr oduced through the exposed PV. Surgical exploration was performed only in t hose patients who exhibited a patent PV, and in patients where the groin wa s poorly visualized due to technical problems. Results. - Regardless of age, contralateral surgery was not considered in 8 8 (70%) of the 125 children. Among the 37 patients that were operated upon, eight had a negative exploration due to an erroneous endoscopic evaluation . Surgery was avoided in 35 (56%) of the 62 infants aged less than 2 years, including nine of the 13 prematures who were previously routinely operated upon. Conversely, in the 63 older patients who were readily spared from su rgical exploration, the videoscopic evaluation allowed appropriate selectio n for contralateral surgery in six. Conclusion. - A routine policy, either of surgery or observation, is no lon ger indicated as a quick, safe and cost-effective method is available to de tect a patent PV. The transinguinal laparoscopy is safe and could be easily performed by surgeons already skilled in pediatric hernioraphy. Therefore, the videoscopic transinguinal contralateral evaluation is worth being prom oted to ensure an appropriate surgery tailored to the anatomical features. (C) 1999 Elsevier, Paris.