Background: The utility of laparoscopic evaluation of the contralateral inguinal ring during pediatric hernia or hydrocele repair remains controversial. As with open surgery this technique has been applied more commonly to hernia than hydrocele.
Methods: From 1994-2004, 300 boys (2 wks-15 yrs) underwent contralateral diagnostic laparoscopy (DL) through the hernia sac. A positive DL was defined as a patent processus vaginalis with the sac >1 cm at exploration. The incidence of positive DL was evaluated in terms of patient age, presenting diagnosis and side.
Results: The incidence of a positive DL was significantly different based on age and diagnosis, but not laterality. There were 2 false positives and surprisingly, 7 false negatives with contralateral hernias developing at a mean of 2.7 years after a negative DL. There were no complications.
Conclusions:
1. An occult patent processus vaginalis is more common in pediatric hydrocele than hernia.
2. There is a higher patency rate with hydrocele in 2-4 year olds (over 40%) than in younger children.
3. Therefore, diagnostic laparoscopy of the contralateral internal ring should be considered in boys (ages 0-4 years) with hydrocele.
4. Despite careful examination, there is a 2% false negative and 1% false positive rate with this technique.

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