Laparoscopic evaluation of contralateral patent processus vaginalis during unilateral inguinal hernia repair
Erdal KARAKAYA, Ali TEKİN, Oğuz ATEŞ, Gülce HAKGÜDER, Mustafa OLGUNER, Feza M. AKGÜR
Dokuz Eylül Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, İzmir
Keywords: Patent processus vaginalis, unilateral inguinal hernia, laparoscopy, Goldstein test
Abstract
Objective: Goldstein test was the method developed for the evaluation of contralateral patent processus vaginalis (CPPV). In recent years, laparoscopic evaluation has become the common method. A retrospective study was performed to evaluate diagnostic efficiency of Goldstein test, laparoscopy and probing of processus vaginalis (PV).
Material and Method: The hospital records of 334 patients, who had been operated on for unilateral inguinal hernia between April 2001 and April 2008, were evaluated retrospectively. To the patients whom their parents wanted CPPV evaluation, after insufflation of CO2 through 3,5-6 mm ports placed inside the ipsilateral hernia sac, the contralateral inguinal canal was palpated for crepitation (Goldstein test). Then with a 2,9-5 mm diameter 30° angle scope, the patency of the internal ring and bubble formation with external compression at the internal ring was evaluated. In inconclusive patients, PPV depth measured with a probe. A wide open internal ring and a PV deeper than 1.5 cm were considered as PPV.
Results: Goldstein test was found positive in 104 (31 %) patients and negative in 230 (% 69) patients. With laparoscopy, contralateral internal ring was found closed in 268 (% 80) patients, wide open in 38 (12 %), while in 28 (8 %) patients probing of PV was needed. In these 28 patients, depth of the PV was measured with a probe and in 21 patients PV was found deeper than 1.5 cm or deeper. In 59 (18 %) patients who were considered as having a CPPV according to laparoscopic inspection and probing of PV, underwent contralateral groin exploration and in all patients PPV was found and high ligated. During the follow up of the 268 patients with negative laparoscopic findings (no PV present) until January 2009, 3 (1,3 %) patients developed metachronous contralateral hernia (MCH).
Conclusion: Laparoscopy is a reliable and efficient method for evaluating the presence of CPPV. We think that laparoscopy should be the preferred method for the evaluation of CPPV. Although presence of CPPV does not mean a MCH will develop, our opinion is that determining and ligating CPPV will mostly prevent development of MCH.