title: The role of laparoscopic evaluation to detect a contralateral defect at initial presentation for inguinal hernia repair.
abstract: Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective  review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients  presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH (P = 0.0168). CPPV was associated with prematurity (P = 0.0003) and age younger than 6 months  (P = 0.0001) but not with sex (P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscopy. Although the rate of CPPV decreases after 6 months of age, girls older than  2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.
authors.affiliation: Kentucky Children's Hospital and the Division of Pediatric Surgery, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0298, USA. john.draus@uky.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Draus
authors.forename: Sarah
authors.initials: S
authors.lastname: Kamel
authors.forename: Aaron
authors.initials: A
authors.lastname: Seims
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery