Hydrocele repair / Hydrocelectomy

Hydrocele repair/ Hydrocelectomy

Table of Contents

We were told by a doctor that our son has a hydrocele. Is a hydrocele dangerous?

A hydrocele contains fluid, and may present as discoloration and swelling of the scrotum. It is due to a patent opening and tract that extends from the tummy to the groin or genitalia, but this opening is smaller than an inguinal hernia. A hydrocele can be communicating due to an open tract, or non-communicating (the opening is closed, but fluid still resides within the tract). A hydrocele may be secondary to other causes which needs to be excluded for example infection, tumour or torsion of the testis. 

When is the best time to repair a pediatric hydrocele?

The best time to repair a hydrocele is classically advocated after 2 years old, but the evidence is not strong(1). I have seen hydroceles that occur at birth resolve by themselves at 3 to 4 years old. This is because during the first years of life, there is a good chance that the opening in the tummy closes by itself and fluid is reabsorbed by the body. This is often seen in communicating hydroceles noted from birth. A hydrocele that is first noticed in childhood or adolescence is different and may be a non-communicating hydrocele.

Can oral medicine treat a hydrocele?

No medicine can cure a hydrocele. Surgery is needed to repair the opening of the tract, and drain the fluid.

What happens during the repair of a hydrocele in a child?

In a child, the surgery to repair a hydrocele is similar to the repair of an inguinal hernia. If the child is fit, I advise a keyhole scope (laparoscopy) is advised to visualize both inguinal openings. There is up to 50% of patients who have a concurrent patent opening and tract on the other side of the tummy(2). When there is a patent opening on the other side of the tummy, it evolves into a hernia in 5 to 20% of patients in the future(3). I recommend a repair of the other side to prevent undergoing a second anaesthesia in future.

A laparoscopic repair can be performed if there are bilateral hydroceles. Under general and local anaesthesia, keyhole incisions are made to insert the laparoscopic instruments. The opening(s) in the groin is then repaired. The instruments are removed and the wounds are closed with absorbable stitches. If there are reasons against a laparoscopic hydrocele repair, I perform the operation via an open technique. 

For the open technique, a groin skin crease incision is made, the opening and tract are repaired. The wound is closed with absorbable stitches. 

When there is a need to examine the testis, an additional scrotal incision may be needed. In the repair, the fluid is drained and the tract is closed surgically.

How is the recovery after a hydrocele repair?

Your child goes home on the same day. Minimal bleeding is expected from the wound. This is a clean surgery and oral or topical antibiotics is not required. The patient can have normal baths. Painkillers may be required for the first 2 days. In babies, it is adviseable to change the diapers 2 to 3 hourly to keep the wound clean. A scab forms over the wound normally in the first 2 weeks and drops off with time. Some swelling may occur in the scrotum or genitalia after surgery and is the normal body reaction after surgery. This resolves by 6 weeks. 

Risks of the surgery are infection, recurrent scrotal swelling, damage to the testis, ascending testis and repeat surgery. Infection presents as redness, swelling, pain, warmth and abnormal discharge of the wound site(s). If any of these complications occur, treatment is available and your doctor should be consulted early. It is important to avoid swimming and exercise for 4 weeks to allow the wound to have good healing and strength.

Are there alternatives to hydrocele repair?

Monitoring and waiting for the hydrocele to resolve by itself is an option. This is less likely with increasing age. If there are signs of pain or increasing swelling, a paediatric surgeon should be consulted.

References

1.         Chen Y, Wang F, Zhong H, et al. A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Surg Endosc. 2017 Dec;31(12):4888–901. 

2.         Jin Z, Wang F. Effectiveness of Laparoscopy in the Treatment of Pediatric Hydrocele: A Systematic Review. J Laparoendosc Adv Surg Tech A. 2018 Dec;28(12):1531–9. 

3.         Esposito C, Escolino M, Turrà F, et al. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg. 2016 Aug;25(4):232–40.

 

Patent opening and tract in a hydrocele
Figure 1: Patent opening and tract in a hydrocele

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Dr Wong Zeng Hao
Dr Wong Zeng Hao

Paediatric Surgery & Urology International

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