Diagnostic pneumoperitoneum for the detection of the clinically occult contralateral hernia in children

The detection and management of occult contralateral hernia in children who present with a clinically evident unilateral hernia have evoked controversy. Routine use of herniography, intra-operative probing of the contralateral inguinal area and routine or selective exploration of the contralateral groin all have their advocates and detractors. During the last 5 years we have used intraoperative pneumoperitoneum and we report our experience in 64 patients 3 months to 9 years old. A retrospective analysis of the data revealed that pneumoperitoneum was negative in demonstrating a contralateral inguinal hernia in 59 of 64 patients (92%). Contralateral exploration was not performed in patients in whom pneumoperitoneum was negative. All 5 patients who tested positive had an indirect inguinal hernia upon contralateral exploration and all 5 were less than 3 years old. Patients who had a negative pneumoperitoneum were followed for up to 5 years and only 1 (1.8%) false negative examination was discovered. Pneumoperitoneum is a safe, effective means to evaluate the contralateral groin for occult hernia at the time of unilateral hernia repair in children.