Open Inguinal Hernia Repair with Transinguinal Laparoscopic Examination in Children: A 13 Years of Experience

Abstract

Purpose: The purpose of the article was to review the thirteen years of experience and evaluate the usefulness of open inguinal hernia repair (OIHR) with transinguinal laparoscopic exploration of contralateral groin (TILE), the prevalence of contralateral patent processus vaginalis (CPPV), and the incidence of metachronous inguinal hernia after negative laparoscopic examination in pediatric patients with unilateral inguinal hernia. Methods: We analyzed data from children aged 15 years and younger who underwent inguinal hernia repair between 2007 and 2019. We performed an OIHR with TILE to assess the contralateral groin, and TILE was accomplished via ipsilateral hernia sac. We collected the medical records and analyzed demographics, operation-related information, including the prevalence of CPPV and the incidence of metachronous contralateral inguinal hernia (MCIH). Results: Of the 1,702 patients with unilateral inguinal hernia, 440 patients (25.9%) had CPPV. The risk factors of CPPV were younger age, female, and left inguinal hernia. The operation results of OIHR with TILE, such as postoperative pain, cosmetic results, recurrence rate, and recovery time was similar to other reports, including open and laparoscopic repair, if not better than LIHR. There were no complications associated with transinguinal laparoscopic exploration. Also, 28 patients (2.2%) with obliterated PV still developed an MCIH later. Conclusion: OIHR with TILE is valuable and safe to detect CPPV in the laparoscopic era. There has been some development (2.2%) of MCIH after negative laparoscopic exploration, which suggested that even though PPV is a significant risk factor for developing a pediatric inguinal hernia, other factors also might be involved in the pathophysiology of pediatric inguinal hernia. OIHR with TILE may be a good surgical option because it compensate for the weakness of OIHR alone and has some advantages of LIHR alone. Two methods can also complement each other and might be tailored to the particular needs of individual patients.