Juang David, Garey Carrisa L, Ostlie Daniel J, Snyder Charles L, Holcomb George W, St Peter Shawn D
Department of Surgery, Center for Prospective Clinical Trials, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
J Laparoendosc Adv Surg Tech A. 2012 Mar;22(2):200-2. doi: 10.1089/lap.2011.0092. Epub 2011 Nov 2.
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.
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.
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.
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.
腹股沟疝修补术是当今小儿外科医生进行的最常见手术。腹腔镜检查已被证明对评估对侧腹股沟区域既敏感又特异。尽管经腹股沟腹腔镜检查具有吸引力且已取得成功，但我们报告了一系列使用该工具后的疝病例。
经机构审查委员会批准后，完成了对我们机构2002年1月至2010年6月期间对接受单侧腹股沟疝修补术并经腹腔镜对侧评估的儿童的经验回顾。记录的数据包括性别、首次就诊年龄、首次疝的侧别、第二次就诊年龄以及初次手术的手术时间。
2002年至2010年，1291例患者接受了单侧腹股沟疝修补术，腹腔镜对侧内环评估为阴性。有32例患者（2.5%）随后出现对侧腹股沟疝。均为男性。首次就诊的平均年龄为42.7个月。发现对侧疝发生的平均时间为16.7个月，中位数为12.2个月。初次手术的平均手术时间为25.6分钟。
当使用腹腔镜检查对侧腹股沟区域时，外科医生应意识到阴性检查仍可能与临床上发生疝的小几率相关。
