Whether to perform unilateral or bilateral groin surgery on a child who has a unilateral hernia has been a surgical controversy since the 1955 report of Rothenberg and Barnett1 that stated that at operation 74% of infants and children thought to have a unilateral inguinal hernia actually had "bilateral hernias" in the form of a contralaterally patent processus vaginalis. The processus vaginalis is an outpouching of the peritoneum that accompanies the testes in its descent into the scrotum. Usually the proximal segment of the processus vaginalis obliterates around the time of birth. Failure of obliteration leaves an open peritoneal sac, the patent processus vaginalis, which is the site of a potential indirect inguinal hernia.
Rowe and Clatworthy2 studied the natural history of the patent processus vaginalis in a series of 1,965 infants and children who had a unilateral inguinal hernia and who were subjected to bilateral groin exploration.