Inguinal hernia in children: ultrasound vs. surgery - Tips from Other Journals

Author: Barbara Apgar
Date: May 1, 1997

Repair of inguinal hernias is one of the most commonly performed surgical procedures in children. Because clinically inapparent inguinal hernias are found on the opposite side in as many as 88 percent of children, debate has centered on whether the contralateral side should be routinely explored. Because of the lack of a reliable, noninvasive test for the presence of an occult inguinal hernia, the controversy has not been solved. Chou and associates analyzed the value of ultrasound in the preoperative recognition of clinically apparent and inapparent inguinal hernias in children.

Two hundred sixty children in whom a clinical diagnosis of inguinal hernia had been made underwent ultrasound examination of both sides of the groin before surgery. The contralateral internal inguinal ring was evaluated by means of intraoperative laparoscopy in 141 patients. The findings at ultrasound were compared with the findings at exploratory surgery, intraoperative laparoscopy, or both.

Among the 260 patients who underwent surgery for inguinal hernias, 246 hernias (95 percent) were correctly diagnosed at ultrasound. Ultrasound also enabled accurate diagnosis of hernias in 167 (93 percent) of 179 patients in whom the asymptomatic side of the groin was surgically repaired. Of the 141 patients who underwent laparoscopic study of the contralateral side, 119 had negative results and 22 had results that were positive for hernia or patent processus vaginalis.

Of the patients with positive results, four had no contralateral hernia at surgery, yielding a total accuracy rate of 96 percent at intraoperative laparoscopy only. Eightysix ultrasonographically positive bilateral hernias were confirmed at surgery in 79 patients; only 30 of these cases had clinical evidence of bilateral hernia. Unnecessary contralateral surgery was performed in the remaining seven patients who had false-positive ultrasound findings. However, 49 (22 percent) clinically unilateral cases that proved to be bilateral benefited from bilateral repair in one operation. Overall, a total of 97 percent of confirmable diagnoses were correctly obtained by the use of ultrasound.

The authors conclude that ultrasound is a rapid, reliable, convenient, noninvasive and easily performed screening technique for inguinal hernias in infants and children. The data suggest that ultrasound can prevent unnecessary herniorrhaphy.

COPYRIGHT 1997 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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