WOFAPS 2025 8th World Congress of Pediatric Surgery

Gamze Yılmaz, Mehmet Can, Ökkaş Aytaç Karkıner, Özkan Okur, Arzu Şencan

Behçet Uz Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk Cerrahisi Kliniği, İzmir/ Türkiye

Purpose:
While laparoscopic approaches are gaining popularity in managing female inguinal hernias, open surgery remains widely used in developing countries due to its high cost and the steep learning curve associated with the technique. Bilateral exploration is commonly performed in girls presenting with unilateral hernia. This study compares outcomes of unilateral versus bilateral exploration.

Method:
Girls treated between January 2014 and December 2024 for unilateral inguinal hernia were retrospectively analyzed. Patients were categorized based on surgical outcomes:

· Insufficient exploration: unilateral cases developing metachronous hernia.

· Unnecessary exploration: bilateral cases with no contralateral processus vaginalis (PV).

· Sufficient exploration: unilateral cases without recurrence or bilateral cases with contralateral PV.
Comparisons were made across age groups, especially under 2 years old, and in cases with sliding hernia.

Results:
Of 419 patients, 100 (23.9%) underwent unilateral and 319 (76.1%) bilateral exploration. Median age was 36 months (IQR: 12–72); median follow-up was 53 months (IQR: 22–84). Among bilateral cases, 19 (19%) had no PV on the opposite side. In the unilateral group, 26 patients (8.2%) developed metachronous hernia. Unnecessary exploration was significantly more frequent than metachronous hernia (p = 0.002).
In children under 2, there was no significant difference in exploration appropriateness between unilateral and bilateral approaches (p = 0.417 for right, p = 0.862 for left). Sliding hernia presence strongly correlated with metachronous PV (p < 0.001).

Conclusion:
Open exploration remains a valuable treatment option for girls diagnosed with unilateral inguinal hernia, and bilateral exploration should be reserved for selected cases. Girls with unilateral hernia findings, unilateral exploration appears to be a more appropriate choice. In our study, no clear advantage of bilateral exploration was demonstrated in girls under 2 years of age with either right or left inguinal hernia. Bilateral exploration seems beneficial only in cases of sliding hernia.