Natural history and consequence of patent processus vaginalis (PPV): An interim analysis | 526 patients | 283 PPVs | 132 bilateral (47%) | 116 right (41%) | 35 left (12%) | Planning annual phone follow-up to 18 years of age | Infants under 4 months undergoing laparoscopic pyloromyotomy | 8 children's hospitals | Observational study | Patients with a PPV | weighed less (3.76kg vs 3.9kg, p=0.03) and were | younger (1.1 months vs 1.3 months, p=0.02) | 208 patients responded to at least one annual follow-up | 2 inguinal hernia repair for a symptomatic hernia | 1 orchiopexy and incidental inguinal hernia repair | 116 patients with the PPV have been followed for > 1 year. Longest follow up a patient has had is 4 years. | No additional hernias were identified who have been followed for > 1 year. | Conclusion: Even though at the time of pyloromyotomy, PPV presence is common; the need for hernia repair so far appears to be rare. | https://doi.org/10.1016/j.jpedsurg.2022.09.012 | Source: Fraser JD et.al. | Department of Surgery, Children's Mercy Kansas City, United States | on behalf of the Midwest Ped Surg Consortium | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Natural history and consequence of patent processus vaginalis: An interim analysis from a multi-institutional prospective observational study
Infographic · Mar 2023 · 1 min read
In brief
In brief
Multi-institutional study of 526 infants undergoing laparoscopic pyloromyotomy found 54% had a patent processus vaginalis, with higher rates in younger, lower-weight infants and those born at lower gestational age. Despite high PPV prevalence, only 1.2% required hernia repair within the first year, suggesting most remain asymptomatic and questioning the need for prophylactic intervention.
- 82% of infants undergoing pyloromyotomy had a patent processus vaginalis (PPV), most commonly bilateral (47%) or right-sided (41%).
- PPV was associated with younger age, lower birth weight, and lower gestational age at birth in this cohort.
- Despite high PPV prevalence, only 1.2% required hernia repair within first year, suggesting most PPVs do not become symptomatic early.
- Routine prophylactic hernia repair at time of pyloromyotomy is not supported by this low symptomatic hernia rate.
- Long-term follow-up to age 18 is ongoing to determine lifetime hernia risk in patients with documented PPV.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with three main sections. The top features a title banner, the middle section contains statistics with an illustration of a baby on the left and a doctor figure on the right, and the bottom sections present findings in white text on teal backgrounds with a yellow conclusion box in the lower right corner.
Jason D. Fraser, Yara K. Duran, Katherine J. Deans, Cynthia D. Downard, Mary E. Fallat, Samir K. Gadepalli, Ronald B. Hirschl, Dave R. Lal, Matthew P. Landman, Charles M. Leys, Grace Z. Mak, Troy A. Markel, Peter C. Minneci, Thomas T. Sato, Shawn D. St. Peter on behalf of the Midwest Pediatric Surgery Consortium
Background: The prevalence and natural history of patent processus vaginalis (PPV) are unknown. An interim analysis was performed of a multi-institutional, prospective, observational study in neonates undergoing laparoscopic pyloromyotomy during which bilateral inguinal canals were evaluated.
Methods: Infants under 4 months undergoing laparoscopic pyloromyotomy were enrolled at 8 children's hospitals. The presence of a PPV was evaluated and measurements recorded. Patients with a PPV are undergoing annual phone follow-up to 18 years of age. Interim analysis was performed.
Results: In a cohort of 610 patient, 80 did not have a PPV examined, 4 had consent issues and were excluded, leaving 526 patients. Of these, 433 (82%) were male, median age 1.2 months (IQR 0.9, 1.6), median weight 3.89 kg (IQR 3.4, 4.46), and EGA 39 weeks (IQR 37, 40). There were 283 PPVs, 132 bilateral (47%), 116 right (41%), and 35 left (12%). Patients with a PPV were significantly younger (1.1 months (IQR 0.9, 1.5) vs 1.3 months (IQR 0.9, 1.7), p=0.02), weighed less (3.76kg (IQR 3.35, 4.26) vs 3.9kg (IQR 3.4, 4.5) p=0.03) and had a significantly lower EGA at birth (38 weeks (IQR 37, 40) vs 39 weeks (IQR 38, 40) p=0.003). Of 246 eligible infants, 208 (85%) responded to at least one annual follow-up. Two patients had an inguinal hernia repair for a symptomatic hernia, 49- and 51-days post pyloromyotomy. One had an orchiopexy and incidental inguinal hernia repair 120 days post pyloromyotomy; for a total of 3 (1.2%) hernia repairs. No additional hernias were identified in 116 patients with the PPV patients who have been followed for > 1 year.
Conclusions: The presence of a PPV at the time of pyloromyotomy is common but the need for hernia repair is rare within the first year of life. Continued long-term longitudinal follow-up of this cohort is needed.