Laparoscopic management of infantile hydrocele in pediatric age group

Abstract

Purpose To evaluate laparoscopic management of hydroceles in pediatrics, with evaluation of the internal inguinal ring (IIR) and the PPV (patent processus vaginalis) in different types of hydroceles, and the incidence of the contralateral PPV. Methods The IIR and the type of hydrocele on the same side of 93 patients with 106 infantile hydroceles were evaluated and managed, in addition to contralateral side. Results The IIR on same side was closed in 8.5% (Type I) and patent in 91.5% (Type II and III) with different shapes. Contralateral IIR was open in 88.7% of cases. The operative time was 30.99 ± 7.23 min, with no intra-operative complication. The vas deferens and testicular vessels were secured and there were no injuries or bleeding. The conversion rate was zero, and all procedures (Type II and II) were completed totally laparoscopic. No post-operative complications except a case of tense hydrocele developed scrotal edema that managed conservatively. Conclusion Laparoscopic hydrocelectomy is safe, applicable and feasible for management of different types of hydroceles in pediatrics. The IIR is patent in nearly all cases with/out communication to the hydrocele. The contralateral IIR can be managed in the same session. Laparoscopic hydrocelectomy with/out hydrocelectomy and IIR closure is essential in preventing recurrence.

Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele

“…Ahmed Elhaddad et al conducted a prospective study of 93 male children with 106 hydroceles in which they found type II hydroceles in 73.6% of cases. Type I was found in only 8.5% and type III in the remaining 17.9% [5]. Our study is consistent with the findings of Choi et al who described an open internal inguinal ring in all cases [39].…”

“…Congenital patent processus vaginalis, which permits fluid flow between the peritoneal and tunica cavities, is the primary cause of hydrocele in children. The frequency is about 5.7% [5]. These hydroceles often disappear spontaneously in 18 to 24 months [6].…”

“…This technique feels easier than laparoscopic hernia repairs because, unlike children with inguinal hernias, the peritoneum is usually not thickened and is easier to dissect from the spermatic elements [8]. Most of the previous studies favor single-port single-incision laparoscopic treatment of hernias and hydroceles [5,[11][12][13]. Although for certain conditions the laparoscopic approach still cannot completely replace traditional open surgery, advocates of laparoscopic techniques believe that, over time, open approaches will become fewer and fewer [12,14,15].…”

A Review of Classification, Diagnosis, and Management of Hydrocele

“…Moreover, the diseases in the inguinal scrotum are quite complicated, including many interwoven diseases, such as hydrocele, often associated with inguinal hernia, inflammatory diseases, varicocele. Inguinal scrotum region also has anatomical structures with many complex pathological terms, even between the sexes there are separate pathological terms that are difficult to distinguish 1,2 . This article updates a number of issues related to hydrocele, including knowledge of anatomy, embryology, classification, etiology, clinical manifestations, imaging findings, and management.…”

“…Inguinal scrotum region also has anatomical structures with many complex pathological terms, even between the sexes there are separate pathological terms that are difficult to distinguish. 1,2 This article updates a number of issues related to hydrocele, including knowledge of anatomy, embryology, classification, etiology, clinical manifestations, imaging findings, and management.…”