Closure of contralateral patent processus vaginalis in laparoscopic unilateral inguinal hernia repair: Is it necessary?

Abstract

Introduction: Laparoscopy has increasingly become a preferred method for repairing inguinal hernias in children. However, there is ongoing debate about the necessity of closing the contralateral open internal ring during laparoscopic repair of symptomatic unilateral hernias. This study aimed to determine the incidence of contralateral patent processus vaginalis (PPV) in children undergoing laparoscopic inguinal hernia repair and to evaluate whether closure of the contralateral ring is warranted in asymptomatic patients.

Patients and methods: This study included all children who presented to us with unilateral inguinal hernia. The parameters examined comprised age, gender, side of hernia, the incidence of contralateral PPV and complications. The study was conducted in two phases, each lasting 5 years. In the first phase, if the contralateral processus vaginalis was patent, it was closed following the repair of the symptomatic side. In the second phase, only the symptomatic side was repaired, and the contralateral processus vaginalis was left untreated if patent. All repairs were performed laparoscopically by a single surgeon. The results were analysed to assess the rationale for laparoscopic closure of asymptomatic contralateral PPV.

Results: A total of 1300 patients with unilateral inguinal hernia without any associated pathologies were included in this 10-year study. Six hundred and fifty cases were analysed in each of the two 5-year phases. The mean age of the patients was 34 months (1 month-13 years). Of the participants, 73% were male and 27% were female. The surgical procedure involved ligating the hernia sac (PPV) at the internal ring without division. Follow-up durations varied from 6 months to 5 years, with a mean of 4.2 years. In phase 1, 247 children (38%) had a contralateral PPV (asymptomatic side), which was subsequently closed. In phase 2, 260 children (40%) had a contralateral PPV (asymptomatic side) which was left untreated. Development of a metachronous hernia was seen in only 10% of these cases where the PPV was not closed.

Conclusion: Our results show that upfront closure of the contralateral open ring in children with unilateral inguinal hernia is unnecessary. These patients can be monitored, and the contralateral side should only be repaired if a clinically significant hernia develops.