BOB Ped Surg 2023 - Jason Fraser, APSA - Presentation

The natural history of the patent processus vaginalis (PPV) in the absence of symptomatic hernia is relatively unknown.

There are inconclusive recommendations on managing PPVs when found incidentally at the time of another operation or on the contralateral side during inguinal hernia repair.

The natural history and timing of obliteration of the processus vaginalis is indistinct.

The study enrolled infants less than four months of age undergoing laparoscopic pyloromyotomy with inguinal canal examination.

Patients with a PPV were followed yearly via phone survey up to age 18 years, while those without a PPV were not included or followed.

PPV was measured using the pyloric grasper, whose metal portion length is 2 centimeters and width when opened is 1.5 centimeters.

Of 526 patients analyzed, 283 (nearly 54%) had a PPV: 35 on the left, 132 bilateral, and 116 on the right.

Patients with PPV were significantly younger, weighed less, were more commonly male, and had significantly lower estimated gestational age at birth than those without PPV.

There were 414 PPV dimensional measurements recorded where bilateral PPVs are not separated.

The scrotum and labia most frequently did not insufflate during PPV examination.

Right-sided PPV is more common, but there is similar depth and width of right and left PPVs as determined by ability to visualize the bottom.

Of 246 patients eligible for at least one annual follow-up, 85% responded to at least one yearly follow-up call.

Three patients presented in the first year with an inguinal hernia, with no hernias seen in patients who reached two, three, or four-year follow-up milestones.

There were three inguinal hernias among 246 patients with PPV who had follow-up, representing a 1.2% hernia rate, all occurring in the first year.

There is a high incidence of PPV seen in this patient population (infants under 4 months undergoing pyloromyotomy).

The need for inguinal hernia repair in patients with incidental PPV has been low to date in this cohort.