Lotan Gad, Efrati Yigal, Stolero Sorin, Klin Baruch
Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Isr Med Assoc J. 2004 Jun;6(6):339-41.
Contralateral exploration of the groin has been common practice among pediatric surgeons for nearly 50 years, based on the high incidence of patent processus vaginalis on the contralateral side with the potential for the subsequent development of a hernia.
To evaluate transinguinal laparoscopic examination of the contralateral side during repair of inguinal hernia in children in order to reach a decision regarding exploration of the contralateral side.
Over a 21 month period 124 children with unilateral inguinal hernia underwent laparoscopic evaluation of the contralateral groin. The operations were performed under general anesthesia as ambulatory procedures.
Transinguinal contralateral laparoscopic exploration was positive (patent processus vaginalis) in 26 children (21%) and negative (closed processus vaginalis) in 88 (71%). Failure to introduce the telescope occurred in 10 patients (8%) due to a friable or narrow hernia sac. Twenty-five children below 2 years of age were spared exploration of the contralateral side as a result of the negative laparoscopic examination. On the other hand, 15 children aged 2-17 had their contralateral groin explored because of a positive finding at laparoscopy.
Transinguinal laparoscopic examination of the contralateral side during repair of inguinal hernia in children is a simple, safe and quick method to avoid systematic bilateral explorations and should be part of every pediatric surgeon's experience.
近50年来，小儿外科医生普遍对腹股沟进行对侧探查，这是基于对侧鞘状突未闭的高发生率以及随后发生疝气的可能性。
评估小儿腹股沟疝修补术中对侧经腹股沟腹腔镜检查，以便就对侧探查做出决定。
在21个月的时间里，124名单侧腹股沟疝患儿接受了对侧腹股沟的腹腔镜评估。手术在全身麻醉下作为门诊手术进行。
经腹股沟对侧腹腔镜探查阳性（鞘状突未闭）的患儿有26名（21%），阴性（鞘状突闭合）的有88名（71%）。由于疝囊脆弱或狭窄，10名患者（8%）未能插入腹腔镜。25名2岁以下儿童因腹腔镜检查阴性而免于对侧探查。另一方面，15名2至17岁的儿童因腹腔镜检查结果阳性而接受了对侧腹股沟探查。
小儿腹股沟疝修补术中对侧经腹股沟腹腔镜检查是一种简单、安全、快捷的方法，可避免系统性双侧探查，应成为每位小儿外科医生经验的一部分。
