Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China.
Department of Paediatric Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Br J Surg. 2017 Jan;104(1):148-151. doi: 10.1002/bjs.10302. Epub 2016 Oct 25.
The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV.
Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH. The presence of CPPV was evaluated during laparoscopy and, if detected, the CPPV was closed. The relationship between CPPV and subsequent MIH was studied.
The study included children who had complete follow-up (90·0 per cent of those having open repair and 92·2 per cent of those undergoing laparoscopic repair). Of 2538 children who had open hernia repair, 62 (2·4 per cent) developed MIH (30 on the right side and 32 on the left; P = 0·015). Among 2855 children who underwent laparoscopic repair, a CPPV was identified and closed in 1469 (51·5 per cent). The rate of MIH after negative laparoscopic evaluation for CPPV was three of 2855 (0·1 per cent). There were no significant differences in the rate of CPPV between sexes and either the right or left side (P = 0·072 and P = 0·099 respectively). Ipsilateral recurrence was less frequent after laparoscopic repair: seven (0·2 per cent) versus 26 (1·0 per cent) for open repair (P < 0·001).
Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH.
腹腔镜技术的发展为儿童腹股沟疝的评估和治疗提供了新方法，由此引发了是否有必要同期闭合对侧未闭鞘状突（CPPV）的争议。本研究旨在明确 CPPV 患儿中迟发性腹股沟疝（MIH）的发生率。
来自两家医院的单侧腹股沟疝患儿分别接受开放或腹腔镜修补术，并进行 MIH 随访。腹腔镜检查时评估 CPPV 的存在，如果发现 CPPV，则予以闭合。研究 CPPV 与随后发生 MIH 的关系。
共有 2538 例行开放疝修补术和 2855 例行腹腔镜疝修补术的患儿完成了完整随访（分别占开放修补术和腹腔镜修补术患儿的 90.0%和 92.2%）。在 2538 例行开放疝修补术的患儿中，有 62 例（2.4%）发生 MIH（右侧 30 例，左侧 32 例；P=0.015）。在 2855 例行腹腔镜疝修补术的患儿中，1469 例（51.5%）发现 CPPV 并予以闭合。腹腔镜检查阴性时 CPPV 的 MIH 发生率为 3/2855（0.1%）。CPPV 在性别和左右侧之间的发生率无显著差异（P=0.072 和 P=0.099）。腹腔镜修补术后同侧复发的发生率较低：7 例（0.2%）vs. 26 例（1.0%）（P<0.001）。
腹腔镜疝修补术的复发率低于开放修补术。CPPV 的常规修补可降低随后发生 MIH 的风险，但需闭合 21 例 CPPV 才能预防 1 例 MIH。
