Surgical endoscopy · 2026
Sex-specific predictors of contralateral patent processus vaginalis in unilateral pediatric inguinal hernia or hydrocele: a cohort study of 1031 laparoscopic cases.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Matsumoto Masanaga, Sanmoto Yohei, Masumoto Kouji
Аннотация
BACKGROUND: Asymptomatic contralateral patent processus vaginalis (CPPV) is commonly detected during the laparoscopic repair of inguinal hernias in children and is a risk factor for metachronous contralateral inguinal hernias (MCIHs). However, predicting CPPV preoperatively is challenging, and evidence on its clinical predictors is limited, particularly regarding sex-specific differences. We aimed to identify preoperative predictors of CPPV and to evaluate sex-specific risk factors.
METHODS: This retrospective observational study was conducted at a single tertiary-care university hospital and included children (aged < 16 years) who underwent single-incision laparoscopic percutaneous extraperitoneal closure for a clinically unilateral inguinal hernia or hydrocele between 2013 and 2024. Those who underwent surgery for a recurrent inguinal hernia, MCIH, or bilateral presentation were excluded. The preoperative clinical characteristics were analyzed. Missing data were addressed using multiple imputation before conducting multivariable logistic regression analyses in the overall and sex-stratified cohorts to determine the independent predictors of CPPV.
RESULTS: Overall, 1031 children (502 males, 529 females) were included. CPPV was identified in 511 (49.6%) patients. In the multivariable analysis of the overall cohort, left-sided presentation and history of incarceration were independently associated with CPPV, whereas sex was not. In sex-stratified analyses, hydrocele was independently associated with CPPV in males (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.06-2.45; P = 0.03). In females, left-sided presentation (OR, 2.80; 95% CI, 1.94-4.03; P < 0.001), incarceration history (OR, 5.19; 95% CI, 1.39-19.30; P = 0.014), and older age (OR, 1.01; 95% CI, 1.00-1.01; P = 0.046) were associated with CPPV.
CONCLUSIONS: Preoperative predictors of CPPV showed sex-specific patterns. Sex was not an independent predictor; however, hydrocele was associated with CPPV in males, whereas, in females, left-sided presentation and incarceration history showed strong independent associations with CPPV. These findings may inform preoperative counseling, operative approach selection, and meticulous contralateral laparoscopic exploration, potentially reducing the risk of subsequent MCIH.
METHODS: This retrospective observational study was conducted at a single tertiary-care university hospital and included children (aged < 16 years) who underwent single-incision laparoscopic percutaneous extraperitoneal closure for a clinically unilateral inguinal hernia or hydrocele between 2013 and 2024. Those who underwent surgery for a recurrent inguinal hernia, MCIH, or bilateral presentation were excluded. The preoperative clinical characteristics were analyzed. Missing data were addressed using multiple imputation before conducting multivariable logistic regression analyses in the overall and sex-stratified cohorts to determine the independent predictors of CPPV.
RESULTS: Overall, 1031 children (502 males, 529 females) were included. CPPV was identified in 511 (49.6%) patients. In the multivariable analysis of the overall cohort, left-sided presentation and history of incarceration were independently associated with CPPV, whereas sex was not. In sex-stratified analyses, hydrocele was independently associated with CPPV in males (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.06-2.45; P = 0.03). In females, left-sided presentation (OR, 2.80; 95% CI, 1.94-4.03; P < 0.001), incarceration history (OR, 5.19; 95% CI, 1.39-19.30; P = 0.014), and older age (OR, 1.01; 95% CI, 1.00-1.01; P = 0.046) were associated with CPPV.
CONCLUSIONS: Preoperative predictors of CPPV showed sex-specific patterns. Sex was not an independent predictor; however, hydrocele was associated with CPPV in males, whereas, in females, left-sided presentation and incarceration history showed strong independent associations with CPPV. These findings may inform preoperative counseling, operative approach selection, and meticulous contralateral laparoscopic exploration, potentially reducing the risk of subsequent MCIH.