Diagnostic flexible peritoneoscopy: Assessment of the contralateral internal inguinal ring during unilateral herniorrhaphy

Background: Inguinal hernia is the most common pediatric surgical condition, with 75% of cases presenting unilaterally. No diagnostic study exists to determine preoperatively which children are at risk for subsequent contralateral hernia. The literature is not clear in advising whether surgeons should explore the contralateral side at the time of initial unilateral herniorrhaphy. Methods: Twenty-four patients presenting clinically with a unilateral hernia underwent flexible peritoneoscopy by isolation of the ipsilateral hernia sac and placement of a flexible cystoscope into the peritoneal cavity. After establishing a CO2 pneumoperitoneum, the contralateral side is checked for patency of the internal inguinal ring. Results: Our study found an open internal inguinal ring in 4 of 24 patients examined (16.7%), The other 20 patients were spared the usual routine contralateral exploration. An open contralateral internal inguinal ring was appreciated in two of nine (22.2%) left herniorrhaphy and 2 of 15 (13.3%) right herniorrhaphy patients. This technique requires an average of 4.5 minutes to perform. With 18- to 32-month follow-up, no hernias have developed on the contralateral side. Conclusion: Diagnostic flexible peritoneoscopy is safe, quick, simple, and could be used to evaluate the contralateral internal inguinal ring in unilateral pediatric herniorrhaphy patients. Copyright (C) 1998 by W.B. Saunders Company.