Miltenburg D M, Nuchtern J G, Jaksic T, Kozinetz C A, Brandt M L
Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Surg. 1997 Dec;174(6):741-4. doi: 10.1016/s0002-9610(97)00182-7.
Inguinal herniorrhaphy is the most common general surgical procedure performed in children. The presence of a contralateral patent processus vaginalis forms the basis of the recommendation for contralateral exploration in patients undergoing unilateral herniorrhaphy. However, a patent processus vaginalis does not necessarily go on to become a clinically apparent inguinal hernia.
All published pediatric series, in which patients underwent unilateral inguinal hernia repair and were evaluated for the development of a metachronous hernia, were included. The incidence of and risk factors associated with development a metachronous hernia were evaluated with meta-analysis.
There were 15,310 patients ranging in age from birth to 16 years, including premature infants. Of these, 1,062 patients (7%) developed a metachronous hernia. Gender and age were not risk factors. There was an 11% risk of metachronous hernia if the original hernia was on the left side, a risk that was 50% greater than if the original hernia was on the right. Of patients who developed a metachronous hernia, 90% did so within 5 years. The complication rate of metachronous hernia was 0.5%.
There is no role for routine contralateral groin exploration. High-risk infants and children, especially those who undergo left inguinal herniorrhaphy, may benefit from contralateral groin exploration. If a patent processus vaginalis is found, it should be ligated. Patients who do not undergo contralateral groin exploration should be followed up for 5 years.
腹股沟疝修补术是儿童最常见的普通外科手术。对单侧疝修补术患者推荐进行对侧探查的依据是对侧存在未闭的鞘状突。然而，未闭的鞘状突不一定会发展为临床明显的腹股沟疝。
纳入所有已发表的儿科系列研究，这些研究中的患者接受了单侧腹股沟疝修补术，并对异时性疝的发生情况进行了评估。采用荟萃分析评估异时性疝发生的发生率及相关危险因素。
共有15310例年龄从出生至16岁的患者，包括早产儿。其中，1062例患者（7%）发生了异时性疝。性别和年龄不是危险因素。如果原疝在左侧，发生异时性疝的风险为11%，这一风险比原疝在右侧时高50%。发生异时性疝的患者中，90%在5年内发生。异时性疝的并发症发生率为0.5%。
常规对侧腹股沟探查无必要。高危婴幼儿，尤其是接受左侧腹股沟疝修补术的患儿，可能从对侧腹股沟探查中获益。如果发现未闭的鞘状突，应予以结扎。未接受对侧腹股沟探查的患者应随访5年。
