Spermatic Cord Ultrasonography Guiding Strategy for Optimizing Treatment of Unilateral Inguinal Hernia

Background: The strategies forchildren with initial unilateral inguinal hernia are open or laparoscopic herniorrhaphy. However, the clinical criteria for choosing an optimized treatment remains unclear.In this study, we aim to find a new strategy for optimizing the treatment of unilateral inguinal hernia.  Methods: 1843 boys with left-sided inguinal hernia underwent open or laparoscopic herniorrhaphy were enrolled in our study and were divided into two groups: ultrasonography group (UG) and non- ultrasonography  group (NUG). Spermatic cord ultrasonography was used for detecting the width of spermatic cord (WSC). Age at initial operation, WSC, operative findings, hospitalization expenses, incidence of metachronous inguinal hernia (MIH), rate of contralateral patent processes vaginalis  (CPPV) and complications were recorded and analyzed.  Findings:  In the open herniorrhaphy group, the incidence of MIH in the WSC < 0 · 35 cm of UG was lower than NUG. The patients with left-sided WSC ≥ 0·55 cm all had been confirmed contralateral inguinal hernia. In the laparoscopic herniorrhaphy group, the rate of CPPV in UG was much higher than NUG. There was no significant difference in total incidence of complications between two groups.  Interpretation:  Spermatic cord ultrasonography was helpful for choosing the treatment of unilateral inguinal hernia. Following this strategy may reduce the incidence of MIH, increase the rate of CPPV of laparoscopic herniorrhaphy without any increase in complications.  Funding:  This work was supported by National Natural Science Foundation of China 81901989 and Project funded by China Postdoctoral Science Foundation 2019M652108 and 2018M642463. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This retrospective study was approved by the Institutional Review Board of the Children’s Hospital, Zhejiang University School of Medicine. Patients’ guardian all gave written informed consent.