Hydrocele repair / Hydrocelectomy

Table of Contents

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

A hydrocele contains fluid, and is generally less dangerous compared with a hernia. It is due to a similar problem which is the 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). There are other underlying cause of a hydrocele which needs to be excluded for example infection, tumour or torsion of the testis.

When is the best time to repair a hydrocele?

The best time to repair a hydrocele is classically advocated after 2 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. If the hydrocele persists after 2 years old, it is unlikely to resolve by itself. A hydrocele that is 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 drain the fluid, repair the opening and the tract.

What happens during the repair of a hydrocele?

The surgery to repair a hydrocele is similar to the repair of an inguinal hernia. During discussion with your doctor, a keyhole scope (laparoscopy) may be advised to visualize both inguinal openings. This is because there is a proportion of patients who have a concurrent patent opening and tract on the other side of the tummy. A laparoscopic repair can be performed if there is bilateral hydroceles. The patient is put under general and local anaesthesia, keyhole incisions are made to insert the laparoscopic instruments. The opening(s) in the tummy is then repaired. The instruments are removed and the wounds are closed with absorbable stitches. If there are reasons against a laparoscopic hydrocele repair, the operation can be performed via an open technique. The patient is put under general or regional anaesthesia. A groin skin incision is made, the opening and tract are repaired. The wound is closed with absorbable stitches. When it is a non-communicating hydrocele or 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?

The patient may go 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 to 3 days. In babies, it is adviseable to change the diapers 3 to 4 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 after 4 to 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.

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