Laparoscopic variability of the internal inguinal ring: review of anatomical variation in children with and without a patent processus vaginalis.
OBJECTIVE
Diagnostic laparoscopy is routinely performed at our institution in children with a unilateral inguinal hernia to determine whether the contralateral processus vaginalis is patent. We reviewed the anatomical variability of the inguinal ring at laparoscopy in children with and without a hernia in various age groups.


METHODS
Since 1992, we have performed diagnostic laparoscopy in more than 1,500 children with a known inguinal hernia. Intraoperative imaging was correlated with clinical and operative findings to characterize the anatomical variability of the internal ring.


RESULTS
The internal ring had many variations. The photographs presented show evidence of the progression from the flat closed ring to the widely open sac. Clefts and veils of peritoneum sometimes made determining the exact anatomy difficult. Experience shows that the various anatomical variations are associated with different pathological conditions.


CONCLUSIONS
Characterization of the anatomical variability of the internal ring is essential for determining the patency of the processus vaginalis at diagnostic laparoscopy in children with a known inguinal hernia. We classified these variations in accordance with clinical and surgical findings.
Nixon
Randy G
RG
Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2765, USA.
Pope
John C
JC
Adams
Mark C
MC
Holcomb
George W
GW
Brock
John W
JW
D006552:Hernia, Inguinal / Q000175:diagnosis*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D006848:Testicular Hydrocele / Q000175:diagnosis*; D013737:Testis / Q000473:pathology*