Contralateral inguinal hernia after negative laparoscopic evaluation: a rare but real phenomenon.

BACKGROUND

The procedure of inguinal herniorrhaphy is the most common procedure performed by pediatric surgeons today. Laparoscopy has proved to be both sensitive and specific for evaluating the contralateral inguinal region. Despite the attractiveness that transinguinal laparoscopy offers and the success it has seen, we report a series of hernias after the utilization of this tool.

METHODS

After IRB approval, a retrospective review of our institutions' experience from 1/2002 to 6/2010 with children who underwent unilateral inguinal hernia repair with contralateral evaluation with laparoscopy was completed. Data recorded included sex, age of initial presentation, laterality of initial hernia, age at second presentation, and operative time of initial surgery.

RESULTS

From 2002 to 2010, 1291 patients underwent unilateral inguinal hernia repair with negative laparoscopic evaluation of the opposite ring. There were 32 patients (2.5%) who subsequently presented with an inguinal hernia on the contralateral side. All were men. The average age of initial presentation was 42.7 months. The mean time to occurrence of the contralateral hernia was found to be 16.7 months with a median of 12.2 months. The mean operative time for the initial operation was found to be 25.6 minutes.

CONCLUSIONS

When using laparoscopy to explore the contralateral inguinal region, the surgeon should be aware that a negative exam may still be associated with a small chance of clinically developing a hernia.