Abstract

Objectives: This study aims to describe the real-world consequences of bilateral and unilateral index exploration and to evaluate an intraoperative sliding-positive marker in a female-only cohort.

Patients and methods: We performed a single-center retrospective cohort study of female pediatric patients with unilateral clinical presentation undergoing open inguinal hernia repair between January 2014 and December 2024. Operative findings, including the presence of a sliding hernia, were extracted from operative notes. The index strategy reflected individual surgeon judgment.

Results: A total of 416 female pediatric patients (median age: 36 months; interquartile range, 12 to 72 months) met the inclusion criteria, of whom 99 underwent initial bilateral exploration and 317 underwent initial unilateral exploration. Metachronous contralateral operation occurred in 0/99 (0.0%) after bilateral and 18/317 (5.7%) after unilateral exploration; the 36-month cumulative incidence was 0.0% versus 7.1%. Within the bilateral-exploration subgroup (n = 99), 38 had ipsilateral sliding-positive findings, and 61 had sliding-negative findings; same-session contralateral hernia was detected in 36/38 (94.7%) and 44/61 (72.1%), respectively (adjusted odds ratio 5.39; 95% CI, 1.08-26.78). The sliding-positive rule showed positive predictive value 56.1%, specificity 90.9%, and number needed to explore 1.78.

Conclusion: Our study results suggest that the principal, hypothesis-generating contribution is that an ipsilateral slidingpositive finding may be a practical intraoperative marker enriching selective contralateral exploration in girls; prospective validation is required.

Citation: Can M, Yılmaz G, Okur Ö, Şencan A. Ipsilateral sliding findings and the burden of contralateral exploration in girls with unilateral inguinal hernia. Turkish J Ped Surg 2026;40(3):159-168. doi: 10.62114/JTAPS.2026.275.