What are the indications for inguinal approach to hydrocele treatment?

Updated: Oct 28, 2020
  • Author: Jacob C Parke, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The inguinal approach, with ligation of the processus vaginalis high within the internal inguinal ring, is the procedure of choice for pediatric hydroceles (typically, communicating). If a testicular tumor is identified on testicular ultrasonography, an inguinal approach with high control/ligation of the cord structures is mandated.

In a study by Saka et al, 69 patients with hydrocele underwent either laparoscopic percutaneous extraperitoneal closure (40 patients) or open repair (29 patients), and the safety and efficacy of the two approaches were compared. There were no significant differences in length of operation, anesthesia, or complications for the two procedures; and no recurrences were observed for either procedure. [13]

In addition, the authors reported on the features of the internal inguinal ring (IIR) found in cases of hydrocele and in cases of inguinal hernia treated during the study period. In the cases of hydrocele, 59.1% of the IIRs were narrow patent processus vaginalis (PPV) with a peritoneal veil; for patients with inguinal hernia, 92% of the IIRs were widely opened PPV. [13]

Peng et al reported the successful use of minilaparoscopic procedures in 125 boys (age range, 12-68 months) with multiple peritoneal folds in the hydrocele sac orifice. Modified single-port, double-needle, minilaparoscopic surgery in which an Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing produced outcomes comparable to those with a two-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. The authors suggest that the modified single-port technique is safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles. [14]

Wang et al reported success with single-site laparoscopic percutaneous extraperitoneal closure of the internal ring in 483 children with hydrocele. Their technique, which uses an epidural and spinal needle, required a median operation time of 18 minutes (range, 10-30 min) and no patient developed intraoperative or postoperative complications. [15]


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