The unilateral pediatric inguinal hernia: Should the contralateral side by explored?

Development of herniography as a diagnostic tool has reopened the question of whether the asymptomatic groin should be explored at the time of unilateral herniorrhaphy in infants. In an attempt to provide data toward the formulation of an answer, the authors review 32 yr of experience with 160 infant hernias. They represent a sequential, unselected series of pediatric patients whose hernias were repaired only if confirmed by examination, and whose postoperative fate has been assessed over extended periods of time. Ninety-six percent of the group were able to be evaulated over an average follow-up interval of 20 yr. It was discovered that of the total group of children with hernias, 29% developed a hernia on the opposite side at some time in their lives. The chance of contralateral occurrence was found not to vary with the child's age at time of first repair, but was found to depend on which side the original repair involved; if the first repair was on the left, the child's chance of contralateral involvement was 41%; if on the right, the risk was only 14%. Morbidity was insignificant with the notable exception of testicular atrophy, which occurred in 2% of the group. The authors conclude that despite the 29% overall risk of future contralateral development, bilateral exploration is not justified for two reasons: First, that a number of unnecessary procedures would be performed, two operations to prevent each subsequent right-sided hernia, and six operations to preclude each later left-sided occurrence; Second, that the risk of bilateral testicular trauma, though slight, is too great.