Pediatric Inguinal Hernia: Occult Bilaterality – An Indication for Laparoscopic Repair

Abstract Aim The study aimed to ascertain the incidence of contralateral patent processus vaginalis in patients undergoing laparoscopic inguinal hernia repair. Settings and Design A retrospective review of our cases of Inguinal Hernia operated by Laparoscopic herniotomy in the Department of Pediatric Surgery was done. Subjects and Methods All children who underwent laparoscopic inguinal hernia repair at AIIMS Jodhpur, India, during the period of Sept 2016–2023 were retrospectively studied. Parameters studied included age, gender, side of the hernia, incidence of contralateral patent processus vaginalis and recurrence rates. As per departmental protocol, all patients who had occult bilaterality were repaired in the same sitting after the repair of the presenting side. Results A total of 255 patients were included in the study. The mean age was 44.4 months and varied from 0 months of age to 192 months. Ligation of the sac was performed after or without division, depending on the operating surgeon's preference. The follow-up varied from 3 months to 7 years, with a mean of 3.8 years. 10 patients had a bilateral inguinal hernia at diagnosis, with left-side inguinal hernia in 95 and right-sided hernia in 150 patients. Out of the 245 patients with unilateral inguinal hernia, a contralateral patent processus vaginalis was found in 48 patients (19.5%). We had 7 recurrences in the cohort (2.7%). No recurrence was seen on the contralateral side, which was closed during the primary procedure. All recurrences occurred in patients between 1 and 3 years of age. Two patients had large inguinoscrotal swellings at presentation and 2 patients had spinal dysraphism along with inguinal hernia. Conclusion Bilateral inguinal hernia is universally accepted as an indication to repair a pediatric inguinal hernia through laproscopic route. However, there is often a debate regarding whether laproscopic inguinal hernia repair has a role in managing unilateral inguinal hernia. Our results show that out of our cohort of 244 patients with unilateral inguinal hernia, approximately one fifth of the patients have patent processus vaginalis on the contralateral side. This can be easily repaired in the same setting via laparoscopy without increasing the morbidity and preventing future recurrences to the contralateral side. Take home message Laparoscopic repair of Pediatric inguinal hernia has very acceptable success rates and should be the preferred way to tackle inguinal hernias in children, especially since around a fifth of the patients have contralateral patent processus vaginalis.