True Incidence and Clinical Significance of Patent Processus Vaginalis in Male Adults During Laparoscopic Inguinal Hernia Repair

Aim The exact incidence and clinical significance of patent processus vaginalis (PPV) in adult males is unclear. Perception is that PPVs rarely cause symptoms, but there is very limited data regarding its impact on Quality-of-Life (QoL). Our aim was to estimate the occurence of PPV in all adult male and to assess its influence on QoL using the Carolinas Comfort Scale (CCS). Material and Methods The medical record of all patients who underwent primary laparoscopic TEP inguinal hernia repair between August 2009 and December 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Data was divided into two groups (PPV vs. no-PPV). Recurrent hernia repairs were excluded. Results There were 929 male patients (mean age of 51.9 years) who underwent 1280 inguinal hernia repairs. No intraoperative complications and no conversion to open were encountered. Those with no PPV had significantly more chance of having an associated direct hernia (P <0.0001). After exclusion of all direct hernia repairs in the no-PPV group, the incidence of PPVs was 17.9%. Preoperative modified CCS (MCCS) was completed in 740 patients. After exclusion of all those treated for a direct hernia, PPV patients were experiencing significantly less pain when laying down (P = 0.007) or exercising (P = 0.001). QoL at 2- and 6-weeks postoperative was comparable between both groups. Conclusions The true incidence of PPVs is estimated at 17.9% and seems to prevent the risk of developing an associated direct defect. Patients treated for PPV are less likely to experience pre-operative pain when laying down or exercising.