Predicting contralateral hernia after unilateral inguinal hernia repair in children: a 5-year cohort from Bahrain

Background: Inguinal hernias are common in pediatric surgery, with unilateral presentations being most frequent. The development of a metachronous contralateral inguinal hernia (MCIH) after unilateral repair remains a concern, with reported incidence ranging from 5% to 30%. The decision to perform contralateral exploration remains controversial. Methods: We retrospectively reviewed 202 children (aged 0–14 years) who underwent open unilateral inguinal hernia repair at Salmaniya Medical Complex, Bahrain, between 2019 and 2024. Data were retrieved from operative logs and electronic records. Reoperation for recurrence or contralateral hernia development was documented. Risk factors including prematurity, hernia side, hernia sac size, and comorbidities were assessed for association with recurrence or MCIH using chi-square tests. Results: Of the 202 patients, 75.7% were male and 24.3% female. Preterm infants (<37 weeks) represented 15.8%. Right-sided hernias were more common (60.9%), left side (39.1%). Large hernia sacs were noted in 61.9% of cases. Overall reoperation rate was 8.9% (18/202), with MCIH accounting for 94.4% of cases. Only one patient had a same-side recurrence. No risk factors showed statistically significant association with recurrence or MCIH (p>0.3). For example, reoperation was required in 3.1% of preterm versus 10% of full-term infants (p=0.317). Conclusions: In this cohort, ~9% required reoperation, almost exclusively for MCIH. No traditional risk factors significantly predicted recurrence or contralateral hernia development. These findings suggest that routine contralateral exploration may not be necessary for all patients. Individualized decision-making is recommended, and further studies are needed to identify patients at higher risk for MCIH.