A new technique for laparoscopic exploration to find contralateral patent processus vaginalis

Background: Contralateral inguinal exploration in an infant with a symptoma tic unilateral hernia is controversial. A patent processus vaginalis (PPV) may be found in up to 60% of term infants, and even in a greater number of pre term infants. However, only 10% to 30% of children will subsequently de velop a contralateral hernia when only the symptomatic side is repaired. St andard contralateral laparoscopic inguinal exploration (CLIE) usually is pe rformed through the ipsilateral groin with an angled scope or through the u mbilicus with a 0 degrees scope. A significant number of children have a pe ritoneal veil shrouding the internal ring. To enhance the accuracy of contr alateral groin exploration, we have used a laparoscopic technique of direct ly visualizing the internal ring through a lateral abdominal approach. Methods: From January 1993 through June 1997, we performed 141 CLIE on infa nts younger than 1 year of age with symptomatic unilateral inguinal hernia. After routine dissection on the symptomatic side, the sac was used to insu fflate the abdominal cavity. A needle catheter was inserted on the contrala teral abdominal wall and used to introduce a 1.2-mm scope. If a PPV was ide ntified, the potential hernia was repaired using standard techniques. Results: Of the 141 CLIEs performed on patients younger than 1 year of age, 39 (27.6%) were positive. There were no false-positives. In all, 42 CLIEs (29.7%) were performed on infants born at less than 36 weeks gestation, and 14 of these infants (33.3%) had a positive exploration. The patients were followed for 3 to 57 months. No complications resulted from the technique. One patient had a recurrence on the repaired side. No patients who had a ne gative CLIE subsequently developed a contralateral hernia. Conclusions: The lateral abdominal approach for laparoscopic evaluation of the contralateral groin is safe and accurate, requiring no additional incis ions. Longer follow-up is necessary to determine the true false-negative ra te.