title: Videolaparoscopy of the contralateral internal inguinal ring via the hernia sac in children with unilateral inguinal hernia-initial experience in Brazil, with a meta-analysis.
abstract: Videolaparoscopy of the contralateral internal inguinal ring (CIIR) via the hernia sac was performed in 100 children with a unilateral inguinal hernia (UIH) between August 1996 and May 1999. During general anesthesia, after dissection and opening of the hernia sac with the patient in the Trendelenburg position, the external cannula of a 10-mm trocar was introduced into the peritoneal cavity via the hernia sac. The abdomen was insufflated with CO(2) to a maximum pressure of 9 mmHg. A 10-mm, 30 degrees angled laparoscope attached to a video camera was then inserted through the trocar to examine the CIIR. Routine contralateral inguinal exploration was performed in the first 10 cases and in all children whose videolaparoscopic exam showed an open CIIR. There were no false-positive findings. The positive predictive value of the method was 100% for an open CIIR; the average time needed to perform the examination was 8.06 min. The frequency of an open CIIR was 21% and that of a closed CIIR was 79%. There was no statistically significant relationship between the morphology of the CIIR and the sex or race of the child. The frequency of an open CIIR was significantly higher (34.1%) in children with a left IH, than in those with a right IH (11.8%, chi(2) = 5.95, P = 0.0146). The frequency of an open CIIR was significantly higher (31.1%) in children aged 4 years or older than in those less than 4 years (12.7%, chi(2) = 3.99; P = 0.0456), although the sample was too small to study the correlation between the morphology of the CIIR and age. There were no intra- or postoperative complications. This method for examining the CIIR is safe, efficient and rapid and provides the surgeon with more objective anatomic data for the appropriate selection of children with a UIH who will benefit from contralateral inguinal exploration for ligature of the contralateral patent Processus vaginalis, during the same anesthetic in order to prevent a possible subsequent contralateral indirect IH. Our initial experience is presented with a meta-analysis.
authors.affiliation: Department of Pediatric Surgery, University Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. mellerm@medicina.ufmg.br
authors.forename: Marcelo
authors.initials: M
authors.lastname: Eller Miranda
authors.forename: José Carlos Brandão
authors.initials: JC
authors.lastname: Duarte Lanna
mesh_terms: D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D014741:Video Recording