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Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side

Mollen, Kevin Pa; Kane, Timothy Da,b

Current Opinion in Pediatrics: June 2007 - Volume 19 - Issue 3 - p 344–348
doi: 10.1097/MOP.0b013e3281574597

Purpose of review The evaluation for and management of a contralateral patent processus vaginalis in children presenting with a unilateral inguinal hernia has been debated for over 60 years. The emergence of transinguinal laparoscopy as an evaluative tool has changed the landscape of the debate, offering a safe and minimally invasive option. The review will highlight some of the significant recent contributions to this debate.

Recent findings Recent studies have confirmed the safety of transinguinal laparoscopy, and demonstrated a high level of sensitivity and specificity for it in the evaluation of the contralateral inguinal ring. In comparison, the practice of physical examination under anesthesia for evaluation of the contralateral inguinal region has proven to be ineffective. Further, age and gender differences in the incidence of contralateral patent processus vaginalis have recently been challenged. These data call into question the practices of routine or selective open inguinal exploration and present laparoscopy as the most effective means of evaluation.

Summary Transinguinal laparoscopy offers a safe and effective means of evaluating the contralateral inguinal ring during ipsilateral hernia repair. The relatively high incidences of both contralateral patent processus vaginalis and contralateral metachronous hernia development in children justify the use of routine laparoscopic evaluation.

aDepartment of Surgery

bDivision of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Correspondence to Timothy D. Kane, MD, Assistant Professor of Surgery, Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA Tel: +1 412 692 7282; fax: +1 412 692 8299; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.