J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 2093-0488 The Korean Surgical Society 10.4174/jkss.2011.80.2.142 Original Article Clinical Analysis of Metachronous Inguinal Hernia in Children Park Taejun M.D. Jung Eunyoung M.D. Park Woo-Hyun M.D. Choi Soon-Ok M.D. Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. Corresponding author (choi1635@dsmc.or.kr) 02 2011 07 02 2011 80 2 142 146 29 10 2010 18 12 2010 Copyright © 2011 The Korean Surgical Society 2011 Purpose

The purpose of this study is to identify the incidence of metachronous contralateral inguinal hernia (MCH) and how early patients visit hospital upon discovering the presence of a lump on the contralateral side after initial hernia repair.

 Methods

This is a retrospective study of 2,169 patients with inguinal hernia between January 2001 and January 2010 at a single institution. We evaluated the occurrence of MCH among 1,689 consecutive unilateral inguinal hernia (UIH) patients who were treated in our department. We also analyzed and compared the time lag (number of days) between noticing the presence of hernia and hospital visit between UIH and MCH.

 Results

A total of 102 patients with MCH underwent initial UIH repair during the study period. The incidence of MCH was 6.0% and was slightly higher in males (6.7%) than in females (3.5%). The patients with left inguinal hernia (7.3%) had higher incidence of developing MCH than those with right (5.2%). When we analyzed the patients with MCH, 69.6% of them were under age 5 and 74.6% of MCH occurred within 2 years after initial UIH repair. Seventy-three percent of the patients with MCH, whose time lag was over one month when the first episode of UIH occurred, visited hospital later as MCH occurred.

 Conclusion

The incidence of MCH within the study period is 6.0%. It is slightly higher in males and in patients with left inguinal hernia. Most MCH occurred under age 5 and within 2 years after initial UIH repair.

 Inguinal hernia Metachronous Unilateral Child Ron O Eaton S Pierro A Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children Br J Surg 2007 94 804 811 Burd RS Heffington SH Teague JL The optimal approach for management of metachronous hernias in children: a decision analysis J Pediatr Surg 2001 36 1190 1195 Han YJ Nam SH Kim DY Kim SC Kim IK Contralateral Incidence of Pediatric Inguinal Hernia and Hydrocele after Unilateral Operation J Korean Assoc Pediatr Surg 2008 14 48 57 Kwon YJ Rhim SY Jung PM Clinical study of contralateral inguinal hernia development in children with unilateral inguinal hernia J Korean Assoc Pediatr Surg 2007 13 187 193 Manoharan S Samarakkody U Kulkarni M Blakelock R Brown S Evidence-based change of practice in the management of unilateral inguinal hernia J Pediatr Surg 2005 40 1163 1166 Moss RL Hatch EI Jr Inguinal hernia repair in early infancy Am J Surg 1991 161 596 599 Grosfeld JL Grosfeld JL Pediatric Surgery Inguinal Hernias and Hydroceles 2006 6th ed Philadelphia Mosby Elsevier 1269 1287 George W Holcomb I Murphy JP Ashcraft KW Ashcraft's pediatric surgery Inguinal Hernias and Hydroceles 2010 5th ed Philadelphia Elsevier Saunders Rothenberg RE Barnett T Bilateral herniotomy in infants and children Surgery 1955 37 947 950 Tackett LD Breuer CK Luks FI Caldamone AA Breuer JG DeLuca FG Incidence of contralateral inguinal hernia: a prospective analysis J Pediatr Surg 1999 34 684 687 discussion 7-8 Zamakhshardy M Ein A Ein SH Wales PW Predictors of metachronous inguinal hernias in children Pediatr Surg Int 2009 25 69 71 Holcomb GW 3rd Miller KA Chaignaud BE Shew SB Ostlie DJ The parental perspective regarding the contralateral inguinal region in a child with a known unilateral inguinal hernia J Pediatr Surg 2004 39 480 482 discussion-2 Yoon WH Young HC Chun YS Clinical study of inguinal hernia in pediatric patients J Korean Assoc Pediatr Surg 2009 15 44 51 Ikeda H Suzuki N Takahashi A Kuroiwa M Sakai M Tsuchida Y Risk of contralateral manifestation in children with unilateral inguinal hernia: should hernia in children be treated contralaterally? J Pediatr Surg 2000 35 1746 1748

Numbers and proportion of metachronous inguinal hernia (MCH) by age group. Note that the highest percentage of patients are preschool children (54.9%) and 69.6% of patients with MCH are under age 5.

Occurrence of MCH after initial repair. The numbers above each box indicate proportions and in the box show the number of patients. Note that 74.6% of MCH occurred within two years.

Time lag of hospital visit after notice of metachronous inguinal hernia compared to the first unilateral inguinal hernia. Amid 84 cases, 48.8% of patients visited earlier than the first event, whereas, 39% of them visitedlater. Patients who visited earlier at the first occurrence of unilateral inguinal hernia, with a history of less than 1 month, tend to visit earlier the second time (61%) and vice versa (73%).

Number of patients and incidence of metachronous contralateral inguinal hernia according to site (P=0.081)

*Rt to Lt means left metachronous inguinal hernia after initial right hernia repair; †Lt to Rt means right metachronous inguinal hernia after initial left hernia repair.

Number and incidence of metachronous contralateral inguinal hernia by sex