Intraoperative diagnostic pneumoperitoneum (Goldstein test) in the infant and child with unilateral inguinal hernia.
Over a 3 year period, 191 infants and children underwent operative repair of inguinal or communicating hydroceles or both. Of these patients, 131 underwent the Goldstein test to determine the presence or absence of a contralateral hernia sac. The Goldstein test was performed by introducing a soft rubber catheter through the hernia sac into the abdominal cavity and distending the peritoneal cavity with air. The contralateral groin and, in males, the scrotum were then palpated for crepitance. The presence of crepitance constituted a positive test result. Of the 131 tests performed, the results were positive in 38 (29 percent) and negative in 93 (71 percent). There was one false-positive test result (2 percent) and no false-negative results. The test was not performed in 60 patients because of technical problems in passing the catheter (22 percent), presence of a ventriculoperitoneal shunt (2 percent), previous contralateral herniorrhaphy (1.6 percent), presentation with bilateral hernias (26 percent), and patient age of 12 years (1 percent). Continued differences in approaches to the management of pediatric patients who present with unilateral groin hernias prompted this study. We believe that the Goldstein test represents a safe, economical, rapid, accurate, and humane approach to this common problem.
Christenberry
D P
DP
Division of Pediatric Surgery, University of South Alabama Medical Center, Mobile 36617.
Powell
R W
RW
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008297:Male; D011028:Pneumoperitoneum, Artificial