Navigating the Pediatric Inguinal Hernia Repair Conundrum: Occult Bilaterality of Patent Processus Vaginalis as an Indication for Laparoscopy.

Introduction: Bilateral inguinal hernia is universally accepted as an indication to repair a pediatric inguinal hernia through the laparoscopic route. However, there is often a debate regarding whether laparoscopic inguinal hernia repair (LIHR) has a role in the management of unilateral inguinal hernia. The aim of the study was to ascertain the incidence of contralateral patent processus vaginalis (PPV) in patients undergoing LIHR. Materials and Methods: A retrospective review of the electronic medical records of cases of inguinal hernia who underwent laparoscopic hernia repair in the department during the period from September 2016 to August 2023. Parameters studied included age, gender, side of the hernia, incidence of contralateral PPV, recurrence rates, and complications. As per the protocol, all patients who had an occult bilaterality discovered intraoperatively were repaired in the same sitting after the repair of the presenting side. A review of the literature was also done to find the rationale behind laparoscopic pediatric inguinal hernia repair. Results: A total of 255 patients were included in the study. The mean age was 45.2 months and varied from 0 months to 192 months. Ligation of the sac was performed after division or without division, depending on the preference of the operating surgeon. The follow-up varied from 3 months to 7 years (mean 3.8 years). Ten (4.08%) patients had bilateral inguinal hernia at diagnosis, with left-side inguinal hernia in 95 (38.77%) and right-sided hernia in 150 (61.22%). Out of the 245 patients with unilateral inguinal hernia, a contralateral PPV was found in 48 (19.5%) patients. We had a total of seven recurrences in the cohort (2.7%), none of which were seen on the contralateral side, which was closed during the primary procedure itself. All of them occurred in patients aged between 1 and 3 years of age. Of the seven children who had recurrence, two patients had large inguinoscrotal swellings at presentation, and two patients had spinal dysraphism (repaired earlier) along with an inguinal hernia. Conclusion: Our results show that out of our cohort of 245 patients with unilateral inguinal hernia, approximately one-fifth of the patients have PPV on the contralateral side. This can be very well repaired in the same sitting via laparoscopy without increasing the morbidity and preventing metachronous hernia on the contralateral side.