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=Abstract=

Inguinal Hernia and Ventriculoperitoneal Shunt

Seong Cheol Lee, M.D., Hyuk Joon Lee, M.D., Ki Hong Kim, M.D., Sung Eun Chung, M.D., Kwi Won Park, M.D., Woo Ki Kim, M.D.

Department of Pediatric Surgery, Seoul National University Children's Hospital Seoul, Korea

Ventriculoperitoneal shunt(VP shunt) for hydrocephalus is thought to inhibit the closure of processus vaginalis and promote inguinal hernia by increasing intraabdominal pressure. To estimate the patency rate of processus vaginalis and the incidence and characteristics of the inguinal hernia, 262 cases of VP shunt in early childhood between January 1980 and May 1998 at Seoul National University Children Hospital were reviewed retrospectively. Inguinal hernia developed in 28 cases(10.7 %), but six patients had an inguinal hernia before the VP shunt was placed. Patients who had a VP shunt before 6 months of age developed inguinal hernia in 16.2 %(12/74) of cases, patients shunted between 6 months and 2 years had an incidence of 12.4 %(11/89) and only 5.1 %(5/99) of patients operated upon after 2 years of age developed hernias. Twenty-two patients out of 256 cases (8.6 %) developed inguinal hernia after VP shunt, with male predominanceCM: F=4.5:1)

.

Eight patients developed inguinal hernia bila- terally(36.4 %). It is suggested that at least 14% of processus vaginalis is patent until 2 years old.

Index Words:

In/?uinal hernia, Hydrocephalus, Ventriculoperitoneal shunt

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Table 1. Incidence of Inguinal Hernia by Sex. Gestational Age and Birth Weight

No. of VP No. of Hernia Hernia p-value shunt

M 156

Sex F 100

<37wk 24

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(2500gm 20

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Total 256

Table 2. Incidence of Inguinal Hernia by the Etiology of Hydrocephalus

Total Hernia Ratio(%)

Neoplasm 60 2 3.3

Arachnoid cyst 37 3 8.1

Meningitis 35 4 11.4

Meningomyelocele 31 2 6.5

AQueductal stenosis 30 3 10.0

Congenital hydro 19 1 5.3

Hemorrhage 10 2 20.0

Communicating hydro 5 1 20.0

Encephalitis 5 1 20.0

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