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P050: BILATERALITY INDEX OF INGUINAL HERNIA IN MALES
Jorge E Huerta, MD; Sergio Sitta, MD; Agustina M López, MD; Federico Cassani, MD; Daniel E Tripoloni, MD; Sanatorio "Dr. Julio Méndez"
Background: Until recently it was accepted that inguinal hernias present bilaterally in around 10% of patients, but since the adoption of ultrasound as a diagnostic method and the laparoscopic approach that enables contralateral exploration, it has been reported higher and variable figures in a range of 14.42% to 56.40%.
Laparoscopy might detect incipient asimptomatic ("hidden") contralateral hernias during hernioplasties; that hernias could enlarge in a short time, because the suppressing of the escape route of intra-abdominal pressure. In other words, "early" metachronous hernias would represent underdiagnosed cases of bilaterality.
As expected, surgeons looking for contralateral hidden hernias with preoperative ultrasound or laparoscopic approach report higher frequencies of bilaterality than those who use open techniques or unilateral PET.
Even the authors who routinely perform laparoscopic hernioplasties report different frequencies of hidden hernias, so their proposals range from the resolution of incipient hernias to the repair of non-existent hernias ("prophylactic hernioplasty").
Many surgeons operate only on symptomatic hernias using open mesh techniques; if a high frequency of bilaterality is confirmed, this behavior could be questioned and more aggressive approaches would be justified.
Objective: To identify cases of metachronous bilaterality (before or after the index operation) in a database of male patients operated on for primary inguinal hernias.
Material and methods:
- Review of records of primary inguinal hernioplasties performed on men during the period 2015-2017.
- Telephone contact to know the development or not of contralateral hernia.
Age, type of hernia and synchronous and metachronous bilaterality were recorded.
Continuous variables were assessed with the “T” test for independent samples and categorical variables with the Fisher exact test. P value of less than 0.05 was considered statistically significant.
Results: 381 records were reviewed: Age x = 57.01 (10.23) years; 44 (11.54%) patients had simultaneous both sides hernias.
254 (59.76%) was indirect hernias, 109 (24.22 %) direct and 26 (6.11 %) mixed.(lack of data in 36 cases)
64 patients (16,79%) had had a previous contralateral hernioplasty.
We got telephone contact with 272 patients: 31 (11.39%) of them underwent surgery for bilateral hernia and 48 (17.64%) had a history of contralateral hernioplasty. During the postoperative follow-up (X = 33.23 months) 12 (6.21%) patients developed contralateral hernia in an average of 34.16 months (SD= 7.82)
Direct and mixed hernias presented as synchronous bilateral more frequently than indirect hernias (14.33% vs 8.45%; p = 0.045) but with respect to postoperative contralateral hernias the difference was not statistically signficant (7.36% vs 2.82%; p= 0.113) (probably type 2 error)
Discussion: We found a low frequency of "early" metacronous contralateral hernias. Our findings do not justify making changes in our diagnostic and therapeutic algorithms, nor do they support prophylactic hernioplasties.
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