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A Comparative Study of Pediatric Inguinal Hernia and Hydrocele: Surgical Characteristics and Diagnostic Implications of the Silk Sign

S. Li¹, C. Wei²

¹Taipei Medical University-Shuang Ho Hospital, Department of Urology, Taipei, Taiwan
²Taipei Medical University-Shuang Ho Hospital, Pediatric Surgery, Taipei, Taiwan

Introduction:

Inguinal hernia and hydrocele are common pediatric conditions arising from the persistence of a patent processus vaginalis (PPV). While clinical diagnosis and physical signs such as the contralateral silk sign are used for preoperative assessment, the decision to perform contralateral exploration remains controversial. This study aimed to evaluate the demographic and surgical characteristics of pediatric patients undergoing laparoscopic repair for inguinal hernia or hydrocele and assess the diagnostic accuracy of the contralateral silk sign in predicting contralateral PPV.

Material and methods:

We conducted a retrospective cohort study from September 2017 to April 2024, including pediatric patients (≤18 years) who underwent laparoscopic repair of inguinal hernia or hydrocele performed by a single pediatric surgeon. Data collected included demographic variables, surgical findings, operative times, and the presence of contralateral silk signs and PPV. Analyses compared male patients with hernia versus hydrocele and males versus females with hernia. The accuracy of the silk sign in predicting contralateral PPV was calculated, and was evaluated through logistic regression. Statistical analyses were performed using SPSS 28.0, with p < 0.05 considered significant.

Results:

A total of 276 pediatric patients were analyzed (211 males and 65 females). Among male patients, 139 had inguinal hernia and 72 had hydrocele; all female patients presented with inguinal hernia. Males with hydrocele were significantly older than those with hernia (p < 0.01), while no differences were observed in gestational age, prematurity, or birth weight. Surgical complexity and operative time were comparable across hernia and hydrocele cases in males. However, females had a significantly shorter operation time than males (p < 0.01). Females preoperatively had a higher proportion of left-sided involvement and a lower proportion of right-sided involvement compared to males. Contralateral exploration revealed bilateral PPV in 49.2% of male and 55.4% of female hernia cases. Subgroup analysis of male patients ≥12 months showed no significant differences in baseline or surgical variables between hernia and hydrocele cases. The predictive value of the contralateral silk sign was limited, with no significant influence from patient age, sex, birth weight, or prematurity. Body weight percentiles also did not impact its accuracy.