Nigel J Hall1, Wonyong Choi, Agostino Pierro, Simon Eaton. 1. Surgery Unit, Department of Paediatric Surgery, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. nigel.hall@ucl.ac.uk
Abstract
PURPOSE: Contralateral groin exploration with closure of a patent processus vaginalis (PPV) in children with a unilateral inguinal hernia remains controversial. We aimed to generate precise, age-related probabilities of patency of the contralateral processus vaginalis (PV) in infants with a unilateral inguinal hernia to guide practice. METHODS: Retrospective review of all unilateral laparoscopic inguinal hernia repairs in 5 years to determine patency of contralateral PV. Using logistic binomial regression, age-adjusted odds ratio (OR), probability of contralateral PPV and number needed to explore (NNE) in order to close all PPVs were estimated. RESULTS: Data from 331 children [262 male, median 3.8 months corrected gestational age (CGA)] were analysed; 160 (48 %) had a contralateral PPV. In the regression model, CGA is linearly related to log[OR] such that for each month increase in CGA, the log[OR] of having a contralateral PPV decreased by 0.017 ± 0.006 (mean ± SEM; p = 0.005). Gender and side of hernia had no significant effect. The probability of contralateral PPV is 50 % (NNE = 2) at 8 m CGA, 33 % (NNE = 3) at 49 m and 25 % (NNE = 4) at 72 m. CONCLUSIONS: These data contribute to our knowledge of the natural history of the PV and may help guide the need for contralateral groin exploration in infants with inguinal hernia.
PURPOSE: Contralateral groin exploration with closure of a patent processus vaginalis (PPV) in children with a unilateral inguinal hernia remains controversial. We aimed to generate precise, age-related probabilities of patency of the contralateral processus vaginalis (PV) in infants with a unilateral inguinal hernia to guide practice. METHODS: Retrospective review of all unilateral laparoscopic inguinal hernia repairs in 5 years to determine patency of contralateral PV. Using logistic binomial regression, age-adjusted odds ratio (OR), probability of contralateral PPV and number needed to explore (NNE) in order to close all PPVs were estimated. RESULTS: Data from 331 children [262 male, median 3.8 months corrected gestational age (CGA)] were analysed; 160 (48 %) had a contralateral PPV. In the regression model, CGA is linearly related to log[OR] such that for each month increase in CGA, the log[OR] of having a contralateral PPV decreased by 0.017 ± 0.006 (mean ± SEM; p = 0.005). Gender and side of hernia had no significant effect. The probability of contralateral PPV is 50 % (NNE = 2) at 8 m CGA, 33 % (NNE = 3) at 49 m and 25 % (NNE = 4) at 72 m. CONCLUSIONS: These data contribute to our knowledge of the natural history of the PV and may help guide the need for contralateral groin exploration in infants with inguinal hernia.
Authors: E S Wiener; R J Touloukian; B M Rodgers; J L Grosfeld; E I Smith; M M Ziegler; A G Coran Journal: J Pediatr Surg Date: 1996-08 Impact factor: 2.545
Authors: Antti I Koivusalo; Reijo Korpela; Kari Wirtavuori; Satu Piiparinen; Risto J Rintala; Mikko P Pakarinen Journal: Pediatrics Date: 2009-01 Impact factor: 7.124