The efficacy of laparoscopic examination of the internal inguinal ring in children.
The ability of physicians to identify a patent processus vaginalis by laparoscopic examination of the internal ring is now well established, but the efficacy on patient outcome is not. The authors reviewed their experience to determine the effect of diagnostic laparoscopy of the internal ring on the management of children with inguinal hernias. The records of 150 children who underwent inguinal surgery were reviewed--75 before (group 1) and 75 after (group 2) pediatric laparoscopy was introduced into the authors' practice. The children in group 1 were selected for unilateral or bilateral surgery based on history, age, sex, side of presentation, and parental preference. For group 2, laparoscopy was an additional option offered to appropriate patients. Laparoscopy was performed in 43 group 2 patients, using an infraumbilical site. The minimum follow-up period was 2 years for group 1 and 1 year for group 2. The mean ages for groups 1 and 2 were 41.2 and 39.7 months, respectively. There were 61 boys and 14 girls in each group. The percentages of right (R), left (L), and bilateral (B) findings, based on clinical observation, were 56.0 (R), 29.3 (L), and 14.7 (B) for group 1, and 58.7 (R), 26.6 (L), and 14.7 (B) for group 2. The incidence of bilateral surgical exploration was similar for the two groups (group 1, 58.6%; group 2, 61.3%). The addition of laparoscopy significantly lowered the incidence of negative explorations (group 1, 16.0%; group 2, 2.6%; P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)
Grossmann
P A
PA
Department of Surgery Education, Blank Children's Hospital, Iowa Methodist Medical Center, Des Moines, USA.
Wolf
S A
SA
Hopkins
J W
JW
Paradise
N F
NF
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics; D008297:Male; D012086:Reoperation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors