J Korean Soc Endosc Laparosc Surg.  2010 Dec;13(2):144-148.

Detection of the Occult Contralateral Inguinal Hernia by thorough Physical Examination and Selective Diagnostic Laparoscopy during Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

• Kim JC
• Sul JY

Abstract

PURPOSE
We determined the rate of an occult contralateral inguinal hernia by conducting only a physical examination for the unilateral inguinal hernia patients who visited our hospital.
METHODS
One hundred thirty nine patients were prospectively evaluated between September 2009 and October 2010. We divided the patients into 3 groups according to a physical examination of the contralateral inguinal area: Group A (no abnormality), Group B (suspicious) and Group C (definite). We defined Group B and Group C as possible occult bilateral hernia. In Group B, selective diagnostic laparoscopy was performed after the totally extraperitoneal herniorrhaphy was finishedover. We analyzed the rate of detecting a contralateral hernia, the positive predictive value and the accordance rate.
RESULTS
Of the 139 patients, the number of patients in Group A, B and C were 113 cases, 4 cases and 22 cases, respectively. The age of the patients ranged from 18~86 years (mean age: 57.1), with a male to female ratio was 7:1. Twenty-six patients (18.7%) had possible occult bilateral hernia. For the left inguinal hernia patients, the incidence of contralateral hernia was 18.2% (12/66). For the right inguinal hernia patients, this was 19.2% (14/73). The detection rate of contralateral hernia by physical examination was 14.1% (19/135) and the positive predictive value was 86.4% (19/22). The accordance rate of simultaneous bilateral hernia was 57.9% for the direct hernia patients and it was 26.3% for the indirect patients. There was no recurrence or metachronous contralateral inguinal hernia occurrence.
CONCLUSION
We can discover occult contralateral inguinal hernia by conducting a careful physical examination of the contralateral inguinal area. Conducting a proper physical examination is very important for detecting inguinal hernia.

Keyword

Physical examination; Occult contralateral inguinal hernia; Detection rate

MeSH Terms

Female
Hernia
Hernia, Inguinal
Herniorrhaphy
Humans
Incidence
Laparoscopy
Male
Physical Examination
Prospective Studies
Recurrence