Comparing Clinical Examination versus Ultrasound in Detecting the Presence of Contralateral Patent Processus Vaginalis in Patients with Inguinal Hernia/Hydrocele in a Developing Country.

Abstract

Background: Inguinal hernias are extremely common conditions in childhood and form a large part of the general paediatric surgical practice. While most hernias are unilateral, bilateral ones are usually recorded. In patients with bilateral hernias, the hernias on the contralateral side may not be clinically detectable at the time of the herniotomy. There has been the debate about the necessity and indications for exploring the apparently normal side during herniotomy. The aim of the study was to compare objectively the sensitivity of silk glove sign and ultrasound in detecting presence of a patent processus vaginalis (PPV).

Materials and methods: This is a prospective comparative study. A total of 79 patients with confirmed unilateral inguinal hernias were examined for the presence of patent contra‑lateral by checking for a positive silk‑glove sign. These patients subsequently had an ultrasound scan done on the same contralateral side by a different senior paediatric surgery resident trained in taking such scans with the supervision of a consultant radiologist (all blinded to the clinical findings). Patients who exhibited both positive clinical and ultrasound findings underwent herniotomies on the symptomatic side accompanied by contralateral exploration. Collated data were entered and analysed using the SPSS software version 27.0. P < 0.05 was considered statistically significant.

Results: The hernias occurred more on the right - 52 (65.8%) and 25 (34.2%) on the left. A total of 53 (67.1%) had hernias, while 26 (32.9%) had hydroceles. The sensitivity, specificity and diagnostic accuracy of the silk glove sign were 100.0% respectively, for all 4 patients that were positive, while the ultrasound scan had a sensitivity of 98.7%, specificity of 100% and diagnostic accuracy of 98.7%.

Conclusion: This study demonstrates that both the silk glove sign and ultrasound are equally effective in detecting the PPV in the contralateral groin of patients with unilateral inguinal hernia and hydrocele. The comparable sensitivities, specificities and diagnostic accuracies between the two methods suggest that either can be reliably used in clinical practice, depending on the availability of resources and the clinician's expertise.