Evaluation of the Role of Ultrasonography in Predicting a Metachronous Contralateral Inguinal Hernia in Children

Abstract

Abstract Background Inguinal hernia remains one of the most common surgical disorders in children. Almost all pediatric hernias are indirect. The incidence of pediatric inguinal hernia is highest during the first year of life and then gradually decreases thereafter. The incidence of contralateral occurrence of an inguinal hernia after unilateral herniorrhaphy has been reported as 5.6 to 22%. The management of the contralateral inguinal hernia in a child with unilateral CIH has been always debated. Routine contralateral exploration of the inguinal canal has been practiced by many surgeons. Routine contralateral exploration may be associated with a high incidence of negative exploration and lengthening of the operative time in addition to possible increasing morbidity in those patients. Aim of the Work This study aims to evaluate the role of preoperative assessment by ultrasonography in predicting contralateral inguinal hernia in children with unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia. Patients and Methods Fifty infants and children presented to pediatric surgery clinic at Ain Shams University and Nasr City Health Insurance Hospitals aged 1 month till 12 years of age complaining of unilateral inguinal hernia without clinical evidence of contralateral inguinal hernia underwent preoperative US. Results Cases with a width of the contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%. Conclusion Ultrasonography is a rapid, sensitive, convenient, and non-invasive method for screening patients with contralateral occult CIH. It is a reliable tool for preventing unnecessary exploration or additional operations at a later stage. It can be performed in all cases of inguinal hernia to determine the necessity for contralateral exploration. Children having a width of contralateral side >3.5 mm at the level of the internal ring determined using the US are likely to be at high risk of developing a contralateral hernia with a sensitivity of 80.0%, specificity of 77.5%, and area under the curve (AUC) of 78.4%.Therefore, we recommend routine preoperative use of ultrasonography for all patients with unilateral CIH to determine which patient should be subjected to a contralateral exploration.