title: An investigation on the mechanism of contralateral manifestations after unilateral herniorrhaphy in children based on laparoscopic evaluation.
abstract: OBJECTIVE
  No straightforward theoretical descriptions explaining the discrepant incidences of metachronous contralateral hernia and positive contralateral patent processus vaginalis (cPPV) exist. The indications for contralateral groin repair are still not clearly defined.
  
  
  METHODS
  During laparoscopic herniorrhaphy, the intraoperative appearances of the internal inguinal rings (IIRs) were characterized and classified in 211 children with symptomatic unilateral inguinal hernias. A total of 125 boys and 86 girls with 130 right-sided and 81 left-sided indirect inguinal hernias were examined. The morphological appearances of the IIRs in patients with cPPV were compared before and after the ligation of the symptomatic IIRs.
  
  
  RESULTS
  Of 211 children, 108 (51%) had positive cPPV findings. The cPPVs had significantly smaller orifices and shorter lengths than those on the side of the symptomatic hernia. Among these children, 24 (22%) patients exhibited morphological changes in their cPPVs, characterized by an upward movement of the overlying peritoneal veil after the closure of the symptomatic hernia.
  
  
  CONCLUSIONS
  Metachronous contralateral hernia might occur because of morphological changes to the cPPV resulting from closure of the symptomatic IIRs. The predicted incidence of contralateral hernia in this series was 11.2%.
authors.affiliation: Department of Pediatric Surgery, Saitama City Hospital, Saitama City, Saitama 336-8522, Japan. tosihikow@jcom.home.ne.jp
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Watanabe
authors.forename: Miwako
authors.initials: M
authors.lastname: Nakano
authors.forename: Masao
authors.initials: M
authors.lastname: Endo
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000002:abnormalities / Q000473:pathology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D016896:Treatment Outcome