title: Diagnostic laparoscopy through deep inguinal ring: a literature-based review on the forgotten approach to visualize the abdominal cavity during emergency and elective groin hernia repair.
abstract: OBJECTIVE
  To systematically review the published literature on the role of diagnostic laparoscopy through deep inguinal ring (DL-DR) during groin hernia repair.
  
  
  METHODS
  Standard electronic databases were searched reporting article in any language on the role of DL-DR during groin hernia repair regardless of the age and sex of patients.
  
  
  RESULTS
  Thirty-one articles on 5745 patients undergoing DL-DR during groin hernia repair were retrieved from the electronic databases. There was 1 randomized, controlled trial, 7 case reports and 2 case series on 58 adult patients mainly targeting assessment of bowel viability following spontaneous reduction of the strangulated groin hernia. Twenty-one articles, either retrospective or prospective case series on 5687 were reported on pediatric patients aiming to detect a contralateral patent processus vaginalis or synchronous groin hernia. Overall, the laparoscopy group had a reduced operative time, reduced length of hospital stay, lower complication rate, and earlier return to normal activity. DL-DR success rates were reported in >95% of patients. Contralateral patent processus vaginalis indicative of inguinal hernia was found in >48% of children. There was no major morbidity reported in any group.
  
  
  CONCLUSIONS
  DL-DR during groin hernia repair may be performed safely when indicated. The routine use of DL-DR is an established practice in pediatric surgery. There is still insufficient evidence to recommend the routine use of DL-DR in adults.
authors.affiliation: Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, UK. surgeon1wrh@hotmail.com
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.forename: Nikhil
authors.initials: N
authors.lastname: Ladwa
authors.forename: Gianluca
authors.initials: G
authors.lastname: Colucci
authors.forename: William F A
authors.initials: WF
authors.lastname: Miles
authors.forename: Mirza K
authors.initials: MK
authors.lastname: Baig
authors.forename: Parv
authors.initials: P
authors.lastname: Sains
mesh_terms: D034841:Abdominal Cavity; D017558:Elective Surgical Procedures / Q000379:methods*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time