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The very large recurrent postoperative scrotal hydrocele after pediatric inguinal hernia repair: a rare problem
Sigmund Hirsch Ein1, Ahmed Nasr, Paul Wales
1Division of General Surgery, Hospital for Sick Children, Toronto, ON, Canada. a_ein@istar.ca
Insights
A very large recurrent scrotal hydrocele after pediatric inguinal hernia repair is rare, occurring in 0.06% of cases, and typically affects older boys. Surgical repair is usually successful, with a scrotal approach recommended if groin ultrasound is normal.
Area of Science:
- Pediatric Surgery
- Urology
- Surgical Complications
Background:
- Recurrent scrotal hydrocele is a rare complication following pediatric inguinal hernia repair.
- This condition can be symptomatic and significantly impact a child's quality of life.
Purpose of the Study:
- To report on the occurrence and management of very large recurrent postoperative scrotal hydroceles in pediatric patients.
- To determine the incidence and characteristics of this rare complication.
Main Methods:
- Retrospective chart review of five pediatric patients diagnosed with very large recurrent postoperative scrotal hydroceles between 1969 and 2007.
- Analysis of patient demographics, recurrence details, surgical repair methods, and follow-up outcomes.
Main Results:
- The incidence of very large recurrent symptomatic scrotal hydrocele after pediatric inguinal hernia repair was found to be 0.06%.
- Recurrences occurred in older boys (11-16 years) and were successfully repaired, with one case of a second recurrence also managed.
- Follow-up revealed no further hydrocele recurrence in any patient.
Conclusions:
- Very large recurrent symptomatic scrotal hydrocele is an uncommon but manageable complication of pediatric inguinal hernia repair.
- In cases with a normal groin ultrasound, suggesting no recurrent inguinal hernia, a scrotal approach for hydrocele repair is often effective.
- This study highlights the importance of considering scrotal hydrocele as a potential postoperative issue in pediatric hernia repair.
Purpose:
To report the rare problem of a very large recurrent postoperative scrotal hydrocele after pediatric inguinal hernia repair.
Methods:
From July 1969 to December 2007 inclusive, the charts of five boys mean age 8 years (range 7 months-16 years) with very large recurrent postoperative scrotal hydroceles were reviewed (Research Ethics Board approval 1000007698).
Results:
In each case, there was a very large recurrent postoperative symptomatic scrotal hydrocele (3 right, 1 left, 1 bilateral). Their ages at the time of these recurrences were between 11 and 16 years; they were repaired within 2-18 months. The first four were repaired via a groin incision on finding no recurrent inguinal hernia. The last two were repaired through a scrotal approach because a groin ultrasound showed no recurrent inguinal hernia. There was 1 second recurrence which was successfully repaired. A followup of 1(1/2)-9 years revealed no recurrent hydrocele.
Conclusions:
The incidence of a very large recurrent symptomatic postoperative scrotal hydrocele after repair of a pediatric inguinal hernia is 0.06% and usually occurs in older boys. If ultrasonography of the groin is normal (since a recurrent inguinal hernia seems unlikely in such cases), this repair can usually be done via a scrotal approach.
