Contralateral Prophylactic Surgery for Unilateral Laparoscopic Percutaneous Extraperitoneal Closure

<p>Purpose: Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) has been adopted as a standard technique for pediatric inguinal hernia in many facilities. Intraoperatively, the contralateral internal inguinal ring may be dilated. In many facilities, surgery is likely performed to prevent the onset of inguinal hernia even in the absence of symptoms. There is no consensus on whether prophylactic surgery should be performed in all patients with a dilated contralateral internal inguinal ring. In this study, we aim to determine the indication for prophylactic surgery.</p><p>Methods: Two hundred fifty-nine unilateral inguinal hernia patients who underwent LPEC in our department were included in this study. Among the patients with contralateral patent processus vaginalis (PPV), prophylactic surgery was performed only on patients with dilated internal inguinal ring of 10 mm or more in boys and 5 mm or more in girls. The clinical records were reviewed retrospectively.</p><p>Results: Contralateral PPV was observed in 95 (36%) patients. Forty-six patients underwent surgery on the basis of our criteria and 49 patients were only monitored. Postoperatively, the contralateral onset of inguinal hernia occurred in five patients, four of which were only observed (1.9% of those who did not receive contralateral surgery), and one had a recurrence after the contralateral procedure.</p><p>Conclusions: We avoid taking countermeasures as much as possible. Although we have limited cases in which contralateral prophylaxis was performed, the rate of postoperative contralateral onset was lower than previously reported. It was suggested that our criteria can be used as a standard. Further study based on a larger number of cases accumulated is desirable, including the long-term course of the disease.</p>