Visualizing the contralateral deep inguinal ring through a pediatric hernia sac may have the potential to avoid unnecessary blind exploration. The benefits of such visualization are not yet proven. The uncertainty involves the question of how significant the 40-60% incidence of patent processus vaginalis is in the subsequent appearance of a hernia. Some feel that the incidence of a subsequent contralateral hernia may be as low as 15%. Series now in progress will establish the efficacy of laparoscopic observation. The surgeon in this case uses the procedure for males under the age of 2 and females under 6 and is building such a series. For premature infants with a hernia, he routinely explores the other side, both because of the higher probabilities and the danger of tearing the tiny sac and causing injury.
A 3 mm, 70 degree scope is inserted into the open hernia sac on the primary side. The site of the opposite deep inguinal ring is visualized. It is located just lateral to the convergence of the external iliac and inferior epigastric vessels. The round ligament of the uterus is seen entering the deep ring which is closed in this case. The prominent medial umbilical ligament, the remnant of the umbilical artery, is seen medial to the inferior epigastrics. There is also uncertainty about the degree of patency and depth of the processus vaginalis as an indication for exploration. Some feel that if the end of the sac cannot be seen, exploration is warranted. The experience of this surgeon so far (~25 cases, 5 indicated explorations) has been that the ring is clearly open or clearly sealed.
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