title: Inguinal hernia in premature boys: should we systematically explore the contralateral side?
abstract: OBJECTIVE
  Bilateral surgery has been largely advocated in premature boys with unilateral inguinal hernia owing to the high incidence of contralateral patent processus vaginalis. Recently, the potential morbidity of herniotomy in low birth-weight babies and the progress in pediatric anesthesia questioned this attitude. This study aims to evaluate the incidence of contralateral metachronous hernia in a large series of premature boys and to compare the morbidity of preventive versus elective surgery.
  
  
  METHODS
  This retrospective multicenter analysis of 964 premature boys presenting with unilateral inguinal hernia operated from 1998 to 2012 included 557 infants who benefited from a unilateral herniotomy and 407 from a bilateral herniotomy (median follow-up 12months).
  
  
  RESULTS
  Contralateral metachronous hernia after unilateral surgery occurred in 11% (n=60) without significant difference according to the initial symptomatic side (9.5% on right vs 13% on left, p>0.05). Postoperative morbidity on the contralateral side was higher after preventive surgery than elective surgery with metachronous hernia (2.45% versus 0.9%, p=0.05) especially for secondary cryptorchidism (1% vs 0%, p=0.03). Despite the risk of metachronous incarcerated hernia, elective surgery did not increase the rate of testicular hypotrophy on the opposite side (0.7%, vs 0.7%, p>0.05).
  
  
  CONCLUSIONS
  Systematic bilateral herniotomy is unnecessary in almost 90% of patients and has a significant morbidity. Secondary surgery for metachronous hernia does not increase the risk of testicular lesion and even reduces the risk of secondary cryptorchidism. These results, along with the risk of hypofertility reported after bilateral surgery, may justify treating only the symptomatic side in premature boys.
authors.affiliation: Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France. Electronic address: o-maillet@chu-montpellier.fr.
authors.forename: Olivier Pierre
authors.initials: OP
authors.lastname: Maillet
authors.affiliation: Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Garnier
authors.affiliation: Département de Réanimation d'Anesthésie Unité d'Anesthésie de Soins Continus Chirurgicaux Pédiatriques CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dadure
authors.affiliation: Département Médical d'Information, CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier
authors.affiliation: Département de chirurgie pédiatrique, Hôpital Mère-Enfant, CHU Nantes, Nantes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
authors.affiliation: Département de chirurgie pédiatrique, CHU Rennes, Rennes, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Arnaud
authors.affiliation: Unité de chirurgie pédiatrique, CHU Morvan, Brest, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Linard
authors.affiliation: Département de chirurgie pédiatrique Hôpital Mère-enfant CHU Limoges, Limoges, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
authors.affiliation: Département de chirurgie pédiatrique, Centre Hospitalier Intercommunal Créteil, Créteil, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Ponet
authors.affiliation: Département de chirurgie pédiatrique urologie CHU Robert Debré, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
authors.affiliation: Département de chirurgie pédiatrique, CHU Lanval, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Breaud
authors.affiliation: Département de chirurgie pédiatrique, CHU Saint Etienne, Saint Etienne, France.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.affiliation: Unité de chirurgie pédiatrique CHU Grenoble, Grenoble, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Piolat
authors.affiliation: Département de chirurgie pédiatrique, Hôpital d'Enfants, CHU Dijon, Dijon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sapin
authors.affiliation: Département de chirurgie pédiatrique, CHU Felix Guyon, Saint Denis, Réunion, France.
authors.forename: Luke
authors.initials: L
authors.lastname: Harper
authors.affiliation: Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalfa
mesh_terms: D005500:Follow-Up Studies; D005865:Gestational Age; D006552:Hernia, Inguinal / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Inguinal/groin hernia; Metachronous hernia; Neonatal anesthesiology; Premature boy; Testicular hypotrophy