Transhernial diagnostic laparoscopy for detection of contralateral subclinical patent processus vaginalis in cases with negative preoperative ultrasound

Introduction and objective
Bilateral inguinal hernias are relatively common in children; this fact has led to a controversy about the necessity of bilateral surgical exploration during the repair of unilateral inguinal hernia in children. The aim of our study is to evaluate transhernial laparoscopy as a tool for the detection of subclinical contralateral patent processus vaginalis (CPPV) in cases with negative preoperative ultrasound (US).
Patients and methods
This prospective study included 60 kids who underwent unilateral herniotomy in the period from October 2015 to October 2016 at Pediatric Surgery Unit, Sohag University Hospitals, Sohag, Egypt. Ethics committee approval was obtained. Patients with bilateral hernia and those with detected subclinical CPPV by preoperative US all were excluded. Two parameters were used for evaluation of subclinical CPPV, using transhernial diagnostic laparoscopy technique: the first was inflation of the contralateral scrotal compartment in males or labia in females and the second was laparoscopic visualization (exploration) of contralateral internal ring. Demographic data, laparoscopic operation time, difficulties in the procedure, and results were all reported and analyzed.
Results
Of 60 patients, 48 were male and 12 were female. Laparoscopic operative time ranged from 5 to 12 min. Hernia side was right in 40 patients (32 male and eight female) and left in 20 patients (16 male and four female). Subclinical CPPV was proved, using transhernial diagnostic laparoscopy technique in five patients and the procedure was completed by contralateral herniotomy.
Conclusion
Transhernial diagnostic laparoscopy, for cases with negative preoperative US regarding CPPV, is a feasible, rapid, safe, accurate method, with easy technique and it seems to be more sensitive than preoperative US.