Laparoscopic exploration of the contralateral groin in children: an improved technique.

ABSTRACT

Repair of inguinal hernias are among the most frequently performed operative procedures in children. Bilateral inguinal hernias (BIH) are common, especially in patients under the age of 2 years, and present both synchronously and metachronously. Most pediatric surgeons perform open exploration of the contralateral groin in infants and young children with symptomatic unilateral inguinal hernias to avoid missing the potential metachronous presentation of BIH. The practice of contralateral groin exploration is controversial because of the increased cost, morbidity, and potentially serious complications associated with open groin exploration. We have developed a technique for laparoscopic exploration of the contralateral groin (LECG) to assess the internal inguinal ring in the asymptomatic groin and to measure the depth of a patent processus vaginalis. A pneumoperitoneum is produced by insufflation through a 14-gauge intravenous catheter placed into the hernia sac of the operated side. A 1.2-mm laparoscope is then passed through another 14-gauge intravenous catheter inserted through the abdominal wall of the contralateral side providing a direct, "in line" view of the internal ring. Depth of patency of >1.5 cm was considered positive and a standard operative repair was performed. In 110 children who underwent LECG the incidence of bilaterality was 21%. This technique is rapid, accurate and was associated with no complications.