Does the laparoscopic treatment of paediatric hydroceles represent a better alternative to the traditional open repair technique? A retrospective study of 1332 surgeries performed at two centres in China

Abstract

PurposeTo evaluate the safety, efficacy and merits of laparoscopic repair in children with hydroceles by comparing the outcomes of laparoscopic repair and the traditional open repair (OR) procedure. The outcomes of the following three laparoscopic percutaneous extra-peritoneal closure (LPEC) approaches were also compared: conventional two-port surgery, transumbilical single-site two-port surgery and single-port surgery.MethodsWe retrospectively compared the demographic, perioperative and follow-up data from the consecutive records obtained for 382 boys who underwent OR and 950 boys who underwent LPEC at two children’s medical centres in China. In the LPEC group, regardless of the hydrocele form, one of the three approaches with percutaneous aspiration was performed: conventional two-port surgery was performed in 387 cases, single-site two-port surgery was performed in 468 cases and single-port surgery was performed in 95 cases. The clinical data and complications were statistically analysed.ResultsPostoperative follow-up data were obtained for all the patients. The mean follow-up time was 36 months (24–48 months) in the OR group and 32.5 months (20–44 months) in the LPEC group. Significant differences in recurrence were not observed between the groups (five in the OR and 10 in the LPEC; P = 0.69). However, the operation time, postoperative hospital stay, incidence of scrotal oedema, incision infection and contralateral metachronous hernia or hydrocele were significantly higher in the OR group than those in the LPEC group (P < 0.01). Eighteen children (4.71%) had a negative exploration of the patent processus vaginalis (PPV) in the OR group. Fourteen children (1.47%) in the LPEC group had a closed internal ring and were converted to a scrotal procedure. Significant differences in the clinical data or complications were not observed between the two centres for the laparoscopic procedure (P > 0.05). Contralateral PPV (cPPV) was found in 18 patients in the single-port group (18.9%). Of the patients affected with cPPV, significant differences were observed between the single-port group and the two-port LPEC group (122 patients, 31.5%, P = 0.016) and the single-site two-port group (the 148 patients, 31.6%, P = 0.013). A contralateral metachronous hernia or hydrocele was found in zero, zero and two cases in these groups, respectively, and significant differences were observed (P < 0.01) between the single-site surgery and the other two laparoscopic approaches.ConclusionsLPEC is safe, feasible and effective for treating hydroceles in children and has the same recurrence rate as OR. However, LPEC is superior in operation time, hospital stay, occurrence of scrotal oedema, incision infection and occurrence of metachronous hernia or hydrocele. The transumbilical single-site two-port procedure has the same cosmetic effect as the single-port LPEC. According to our experience, the two-port LPEC approach is better for diagnosing cPPV and reducing metachronous hernia or hydrocele than the single-port LPEC procedure.

The Operative Time for Unilateral Inguinal Hernia Repair in Children Performed with Percutaneous Internal Ring Suturing (PIRS) or Open Approach Method

“…The comparison of the length of the operative time for the LA and the OA showed that the duration of the operation was statistically significantly shorter for the LA [ 14 ]. Zhang et al published retrospective study results comparing the two methods of hernia repair in pediatric patients from two medical centers in China and concluded that the LA approach allows completing the surgery faster [ 15 ]. The study results by Bertozzi et al comparing their contemporary experience with the LA to historical controls, when surgery was performed with the OA, suggests that operative time with the LA method is shorter [ 16 ].…”

Laparoscopic vs. Open Repair Surgery for the Treatment of Communicating Hydrocele in Children: A Retrospective Study From a Single Center

“…In this development process, if the processus vaginalis is not closed completely and the volume of fluid in the tunica vaginalis cavity is too large, hydrocele can occur. An operation to close the PPV is the preferred treatment (13,14). The traditional OR surgery method first needs to open the inguinal canal and find the PPV for high ligation and turnover of the tunica vaginalis (15).…”

“…In addition, with the development of laparoscopic technology, surgeons have also carried out a large number of comparative studies on OR and LR in the treatment of children with hydrocele (22)(23)(24). Zhang et al (13) reported a retrospective study of 1,332 boys with hydrocele in two centers, including 382 cases in the OR group and 950 cases in the LR group. The LR group was divided into three groups: conventional double port, transumbilical single site double port, and transumbilical single port.…”

“…After the testis enters the scrotum, the processus vaginalis narrows in the middle part of the spermatic cord and becomes tubular. Finally, it is closed above the testis, leaving part of the vagina around the testis, which becomes the tunica vaginalis ( 11 , 13 ). In this development process, if the processus vaginalis is not closed completely and the volume of fluid in the tunica vaginalis cavity is too large, hydrocele can occur.…”

Modification of the Classical Percutaneous Extraperitoneal Procedure for Pediatric Inguinal Hernia to Reduce Complications: A Multiple-Centered Comparison Study

“…A signi cant advantage of laparoscopic ligation is the ability to inspect contralateral defects, which potentially avoids a second operation and additional incision [19][20][21][22] . In pediatric patients, the incidence of recessive hernia is 20.0-43% 23 .…”