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Zhu L, Chen F, Xiong J, Xu W, Zhang H, Huang X, Liu T, Lv Z. Effectiveness of preoperative ultrasonography in predicting metachronous contralateral inguinal hernia in children: a single-arm prospective study using a historical control for comparison. Pediatr Surg Int 2024; 40:33. [PMID: 38206388 DOI: 10.1007/s00383-023-05612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted. METHODS All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results. RESULTS In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively. CONCLUSIONS Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.
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Affiliation(s)
- Linlin Zhu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Feng Chen
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Jing Xiong
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Haorong Zhang
- Department of Ultrasound, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiong Huang
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Tao Liu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Road, Shanghai, China.
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Abdelmotaal YS, Taher H, Kaddah S, Elbarbary M, Elsayem K. Patent processus vaginalis: role of ultrasound in pediatric population with unilateral inguinal hernia and other predictors. Pediatr Surg Int 2023; 40:9. [PMID: 38001365 DOI: 10.1007/s00383-023-05576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Inguinal hernia (IH) repair is a common procedure in the daily practice of pediatric surgeons. In a developing country with limited facilities, it is important to be able to predict and diagnose contralateral patent processus vaginalis (CPPV) to avoid the risk and cost of further surgery. OBJECTIVES To assess the accuracy of ultrasound for the detection of CPPV, using laparoscopic evaluation as a confirmatory test. We also looked for various predictors of CPPV in our study population. METHODS 141 patients were included in this 2-year, cross-sectional prospective study. Inclusion criteria were unilateral inguinal hernia elective patients with no major comorbidities and aged between 2 months and 8 years. Each patient was assessed in outpatient clinics and then a pre-operative ultrasound was conducted. This was followed by laparoscopic evaluation during repair of the hernia. RESULTS Of the 141 patients included, 110 (78%) were males, 121 (85.9%) were born at full term, and 96 (68.1) had right-sided hernia. Mean age was 2.64 ± 1.9 years. Ultrasound was 85.7% sensitive in the detection of CPPV, 90.8% specific, and 90.1% accurate. In our analysis of patients younger than 1 year, right-sided hernia and defect size more than 10 mm were statistically significant predictors for a CPPV. CONCLUSIONS Ultrasound has a high accuracy profile and is a useful alternative in limited resource settings with restricted access to minimally invasive surgery for the prediction of CPPV. Patients younger than 1 year with a right-sided hernia or a manifested hernia defect larger than 10 mm are at a higher risk of having a CPPV.
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Affiliation(s)
- Yehia S Abdelmotaal
- General Surgery Department, Suez Canal University, Ismailia, Egypt.
- Pediatric Surgery Unit, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
| | - Heba Taher
- Pediatric Surgery Unit, Cairo University, Giza, Egypt
| | - Sherif Kaddah
- Pediatric Surgery Unit, Cairo University, Giza, Egypt
| | | | - Karam Elsayem
- General Surgery Department, Suez Canal University, Ismailia, Egypt
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Saguintaah M, Eulliot J, Bertrand M, Prodhomme O, Béchard N, Bolivar-Perrin J, Taleb Arrada I, Simon AH, Baud C, Millet I. Canal of Nuck Abnormalities in Pediatric Female Patients. Radiographics 2022; 42:541-558. [PMID: 35061516 DOI: 10.1148/rg.210145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A groin lump is not an uncommon condition in girls and female infants, and US plays a fundamental role in its exploration. The main pathologic conditions are related to the failure of obliteration of the canal of Nuck. Radiologists should gain a full understanding of the embryology and US anatomy of the inguinal canal before assessing this entity for the first time. An optimal age-adjusted US technique-including examinations at rest and during straining-is essential to help assess the canal of Nuck, diagnose a hernia, and analyze its content. The radiologist must be aware of the various types of hernial content depending on the patient's age, including intestinal, omental, ovarian, or tubouterine hernia, and the US features of each. Incarcerated hernias are common in girls and mostly contain an ovary. In such cases, it is crucial to screen for US signs suggestive of ovarian ischemic damage, thereby calling for urgent surgery. US can also depict a cyst or hydrocele of the canal of Nuck and its complications. Moreover, other rare pathologic conditions involving the inguinal area may be depicted at US, which helps guide appropriate treatment. US is the ideal modality for evaluating an inguinal lump in girls and female infants. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Magali Saguintaah
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Jenny Eulliot
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Margaux Bertrand
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Olivier Prodhomme
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Nancy Béchard
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Julie Bolivar-Perrin
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Ikram Taleb Arrada
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Anne-Hélène Simon
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Catherine Baud
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Ingrid Millet
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
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Staerkle RF, Guglielmetti LC, Bielicki IN, Gaukel S, Frongia G, Hilton S, Fink L, Vuille-dit-Bille RN. Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e21501. [PMID: 32756186 PMCID: PMC7402905 DOI: 10.1097/md.0000000000021501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is still not clear if the contralateral side should be explored in children with unilateral inguinal hernias. The primary aim of the present study was to assess the incidence of metachronous contralateral inguinal hernias (MCIHs) in the pediatric population. The second aim was to assess factors associated with increased risk of MCIH development. METHODS Prospective studies including patients from 0-19 years undergoing unilateral inguinal hernia repair without surgical exploration of the contralateral side between 1947 and April 2020 with a minimal follow-up of one year were searched. Searches included EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. RESULTS Seven studies involving 1774 children (1452 boys (82%) and 322 girls (18%) were identified. Overall the incidence of MCIH was 6%. Incidence of MCIH development was significantly higher in children with initial left-sided (9%) versus right-sided (3%) hernia (OR 2.55 with 95% CI from 1.56 to 4.17; P = 0.0002), in female (8%) versus male (4%) children (OR 1.74 with 95% CI from 1.01 to 3.01; P = 0.0469) and in patients with open (14%) versus closed (3%) contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9; P = 0.0202). There was no significant difference in MCIH development depending on follow-up duration (follow-up of ≤2 years (i.e. 1-2 years): calculated MCIH incidence 5% (95% CI from 0.00 to 0.11%; 3 studies; 569 patients), follow-up of ≥3 years (i.e. 3-4 years): 6% (95% CI from 0.03 to 0.09; 3 studies, 983 patients)) or patients' age (MCIH incidence in children <1 year: 6.9%; older children: 4.5%; OR 1.87 with 95% CI from 0.97 to 3.62; P = 0.0618). CONCLUSIONS Overall incidence of MCIH development is 6%. Initial left-sided hernia, female gender and open CPV are risk factors for MCIH development.
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Affiliation(s)
- Ralph F. Staerkle
- Clarunis University Center for Gastrointestinal and Liver Diseases, Basel
| | - Laura C. Guglielmetti
- Department of Visceral und Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur
| | | | - Stefan Gaukel
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Hilton
- Department of Surgery, University of Colorado, Aurora, CO
| | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St Gallen, Switzerland
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You J, Li G, Chen H, Wang J, Li S. Laparoscopic orchiopexy of palpable undescended testes_ experience of a single tertiary institution with over 773 cases. BMC Pediatr 2020; 20:124. [PMID: 32178653 PMCID: PMC7075009 DOI: 10.1186/s12887-020-2021-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes. Methods Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney if necessary, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension. Results There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral patent processus vaginalis, and laparoscopic percutaneous extraperitoneal closure the hernia sac carry out during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination. Conclusion Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. Furthermore, It could discover a contralateral patent processus vaginalis, and treat at the same time, which avoid the occurrence of metachronous inguinal hernia.
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Affiliation(s)
- Jia You
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Gang Li
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Haitao Chen
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Jun Wang
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Shuang Li
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China.
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Brainwood M, Beirne G, Fenech M. Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 2020; 23:22-29. [PMID: 34760578 DOI: 10.1002/ajum.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The processus vaginalis is a blind-ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.
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Affiliation(s)
- Michelle Brainwood
- Department of Ultrasound Qscan Radiology Clinics College Junction 2-12 Wagner Road Clayfield Queensland 4011 Australia
| | - Geraldene Beirne
- Locum Senior Sonographer Matraville New South Wales 2036 Australia
| | - Michelle Fenech
- School of Health, Medical and Applied Sciences Central Queensland University 160 Ann Street Brisbane Queensland 4000 Australia
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A study of contralateral persistent processus vaginalis in laparoscopic hernia repair in children. Hernia 2019; 23:783-787. [PMID: 30680549 DOI: 10.1007/s10029-019-01895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The introduction of laparoscopy for hernia repair permits intra-abdominal observation of a hernia and contralateral persistent processus vaginalis (CPPV). The current study's aim was to investigate the diameter of opening of an inguinal hernia and CPPV in patients with unilateral inguinal hernia, and to evaluate their correlation with age. METHODS From September 2012 to August 2017, 569 pediatric patients underwent laparoscopic repair of unilateral inguinal hernia. We retrospectively evaluated the size of the hernia and CPPV by measuring the diameter of opening. Pearson correlation analysis and linear-by-linear association were used in the statistical analysis. RESULTS The median age at operation was 32.4 months (range 0.2-219 months). CPPV was observed in 330 patients (58.0%), and its incidence was significantly higher in patients with left inguinal hernias than in those with right inguinal hernias (62.8 versus 54.0%, p < 0.001). The mean diameter of opening for the hernias was significantly larger than that for CPPV (11.2 ± 3.1 vs. 6.1 ± 2.5 mm, p < 0.001). The incidence of CPPV gradually decreased from 77.2% in infants to 46.6% in the oldest age group (≥ 6 years) (p trend < 0.001). The diameter of the opening of a hernia was not correlated with increasing age, and the diameter of the opening of a CPPV was not correlated with increasing age, as well. CONCLUSION The diameters of a hernia and CPPV were identified in the current study, and the diameter was not correlated with increasing age. The incidence of CPPV was more common in patients with left inguinal hernias than in those with right inguinal hernias, and it gradually decreased with increasing age.
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Namgoong JM, Choi WY. Reliability of Preoperative Inguinal Sonography for Evaluating Patency of Processus Vaginalis in Pediatric Inguinal Hernia Patients. Int J Med Sci 2019; 16:247-252. [PMID: 30745805 PMCID: PMC6367528 DOI: 10.7150/ijms.28730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Among childhood illnesses requiring surgery, inguinal hernia is the most common entity. Pediatric inguinal hernia has been traditionally operated through a small incision in the inguinal region. Contralateral metachronous inguinal hernia has been the topic of discussion in pediatric surgeon's domain for a long time. Many studies have been conducted to prevent it from occurring. Although patency of processus vaginalis is known to be the cause of metachronous inguinal hernia, it is difficult to know the status of contralateral processus vaginalis preoperatively when the patient is non-symptomatic. Recently, the introduction of laparoscopic surgery has facilitated the observation and surgery of contralateral inguinal hernia during scheduled surgery of unilateral hernia repair while the processus vaginalis is intact. The standard treatment for inguinal hernia is herniotomy. Laparoscopic inguinal hernia repair has not been widely applied in Korea. The objective of this study was to analyze the accuracy of preoperative sonography results of inguinal lesion on the contralateral side in patients that needed laparoscopic operation of inguinal hernia. Methods: Data of 107 patients who received laparoscopic inguinal hernia repair and evaluation by preoperative ultrasonography at Dongguk University Ilsan Hospital from 2011 to 2015 were analyzed. Results: Preoperative sonography for inguinal lesion had a sensitivity of 20.5%, a specificity of 95.2%, a positive predictive value of 75%, and a negative predictive value of 63.2%. Its accuracy was 64.5%. A total of 107 patients had no inguinal hernia recurrence or metachronous contralateral inguinal hernia. Conclusion: Ultrasonography performed prior to traditional pediatric herniotomy is not enough for accurate diagnosis of patency of processus vaginalis in our retrospective study. Multicenter prospective study is needed to estimate accuracy of sonographic diagnosis for patency of processus vaginalis.
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Affiliation(s)
- Jung-Man Namgoong
- Department of Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Yong Choi
- Department of Surgery, Konkuk University Chungju Hospital, Chungju, Republic of Korea
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Dreuning KMA, Ten Broeke CEM, Twisk JWR, Robben SGF, van Rijn RR, Verbeke JIML, van Heurn LWE, Derikx JPM. Diagnostic accuracy of preoperative ultrasonography in predicting contralateral inguinal hernia in children: a systematic review and meta-analysis. Eur Radiol 2018; 29:866-876. [PMID: 30054793 PMCID: PMC6302883 DOI: 10.1007/s00330-018-5625-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 12/02/2022]
Abstract
Objectives The incidence of children developing metachronous contralateral inguinal hernia (MCIH) is 7–15%. Contralateral groin exploration during unilateral hernia repair can prevent MCIH development and subsequent second surgery and anaesthesia. Preoperative ultrasonography is a less invasive strategy and potentially able to detect contralateral patent processus vaginalis (CPPV) prior to MCIH development. Methods We queried MEDLINE, Embase and Cochrane library to identify studies regarding children aged < 18 years diagnosed with unilateral inguinal hernia without clinical signs of contralateral hernia, who underwent preoperative ultrasonography of the contralateral groin. We assessed heterogeneity and used a random-effects model to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Results Fourteen studies (2120 patients) were included, seven (1013 patients) in the meta-analysis. In studies using surgical exploration as reference test (n = 4, 494 patients), pooled sensitivity and specificity were 93% and 88% respectively. In studies using contralateral exploration as reference test following positive and clinical follow-up after negative ultrasonographic test results (n = 3, 519 patients), pooled sensitivity was 86% and specificity 98%. The AUC (0.984) shows high diagnostic accuracy of preoperative ultrasonography for detecting CPPV, although diagnostic ultrasonographic criteria largely differ and large heterogeneity exists. Reported inguinal canal diameters in children with CPPV were 2.70 ± 1.17 mm, 6.8 ± 1.3 mm and 9.0 ± 1.9 mm. Conclusion Diagnostic accuracy of preoperative ultrasonography to detect CPPV seems promising, though may result in an overestimation of MCIH prevalence, since CPPV does not invariably lead to MCIH. Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and subsequent prediction of MCIH. Key Points • Diagnostic accuracy of preoperative ultrasonography for detection of CPPV in children with unilateral inguinal hernia is high. • Preoperative ultrasonographic evaluation of the contralateral groin assumedly results in an overestimation of MCIH prevalence. • Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and risk factor identification is needed to predict whether CPPV develops into clinically apparent MCIH. Electronic supplementary material The online version of this article (10.1007/s00330-018-5625-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K M A Dreuning
- Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - C E M Ten Broeke
- Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J W R Twisk
- Department of Methodology and Applied Biostatistics, and the Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - S G F Robben
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - R R van Rijn
- Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J I M L Verbeke
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L W E van Heurn
- Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J P M Derikx
- Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Mladenović J, Videnović N, Perić D, Mladenović S, Mladenović K. Surgical treatment of the inguinal canal pathology in children. PRAXIS MEDICA 2018. [DOI: 10.5937/pramed1804035m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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