Maillet Olivier Pierre, Garnier Sarah, Dadure Christophe, Bringuier Sophie, Podevin Guillaume, Arnaud Alexis, Linard Caroline, Fourcade Laurent, Ponet Michel, Bonnard Arnaud, Breaud Jean, Lopez Manuel, Piolat Christian, Sapin Emmanuel, Harper Luke, Kalfa Nicolas
Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
J Pediatr Surg. 2014 Sep;49(9):1419-23. doi: 10.1016/j.jpedsurg.2014.01.055. Epub 2014 Feb 10.
Bilateral surgery has been largely advocated in premature boys with unilateral inguinal hernia owing to the high incidence of contralateral patent processus vaginalis. Recently, the potential morbidity of herniotomy in low birth-weight babies and the progress in pediatric anesthesia questioned this attitude. This study aims to evaluate the incidence of contralateral metachronous hernia in a large series of premature boys and to compare the morbidity of preventive versus elective surgery.
This retrospective multicenter analysis of 964 premature boys presenting with unilateral inguinal hernia operated from 1998 to 2012 included 557 infants who benefited from a unilateral herniotomy and 407 from a bilateral herniotomy (median follow-up 12months).
Contralateral metachronous hernia after unilateral surgery occurred in 11% (n=60) without significant difference according to the initial symptomatic side (9.5% on right vs 13% on left, p>0.05). Postoperative morbidity on the contralateral side was higher after preventive surgery than elective surgery with metachronous hernia (2.45% versus 0.9%, p=0.05) especially for secondary cryptorchidism (1% vs 0%, p=0.03). Despite the risk of metachronous incarcerated hernia, elective surgery did not increase the rate of testicular hypotrophy on the opposite side (0.7%, vs 0.7%, p>0.05).
Systematic bilateral herniotomy is unnecessary in almost 90% of patients and has a significant morbidity. Secondary surgery for metachronous hernia does not increase the risk of testicular lesion and even reduces the risk of secondary cryptorchidism. These results, along with the risk of hypofertility reported after bilateral surgery, may justify treating only the symptomatic side in premature boys.
由于对侧鞘突未闭的发生率较高，双侧手术在单侧腹股沟疝的早产男婴中得到了广泛提倡。最近，低体重儿疝修补术的潜在发病率以及小儿麻醉的进展对这种态度提出了质疑。本研究旨在评估大量早产男婴中对侧异时性疝的发生率，并比较预防性手术与择期手术的发病率。
这项对1998年至2012年接受单侧腹股沟疝手术的964例早产男婴的回顾性多中心分析包括557例接受单侧疝修补术的婴儿和407例接受双侧疝修补术的婴儿（中位随访12个月）。
单侧手术后对侧异时性疝的发生率为11%（n = 60），根据初始症状侧无显著差异（右侧为9.5%，左侧为13%，p>0.05）。预防性手术后对侧的术后发病率高于伴有异时性疝的择期手术（2.45%对0.9%，p = 0.05），尤其是继发性隐睾（1%对0%，p = 0.03）。尽管存在异时性嵌顿疝的风险，但择期手术并未增加对侧睾丸萎缩的发生率（0.7%对0.7%，p>0.05）。
在几乎90%的患者中，系统性双侧疝修补术是不必要的，且发病率较高。异时性疝的二次手术不会增加睾丸病变的风险，甚至会降低继发性隐睾的风险。这些结果，连同双侧手术后报道的生育力低下风险，可能证明仅治疗早产男婴的症状侧是合理的。
