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Surgery for hydrocele in children-an avoidable excess?
Nigel J Hall1, Ori Ron, Simon Eaton
1UCL Institute of Child Health, London WC1N 1EH, UK. n.hall@ich.ucl.ac.uk
Insights
Many hydrocele surgeries in boys may be unnecessary. Delaying patent processus vaginalis (PPV) ligation could reduce procedures without increasing harm, warranting further study.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Optimal timing for patent processus vaginalis (PPV) ligation in boys with hydrocele lacks consensus.
- Early surgery may be unnecessary if PPV closes spontaneously, leading to excess procedures and costs.
Purpose of the Study:
- To evaluate the necessity of early PPV ligation for hydrocele in boys.
- To investigate the potential for spontaneous PPV closure and its impact on surgical indications.
Main Methods:
- Conducted a systematic literature review on PPV ligation timing.
- Performed a population-based study on annual PPV ligations and age at surgery in England.
Main Results:
- Hydroceles often resolve before age 2; natural history beyond this is unclear.
- Average 2878 annual hydrocele operations in English children, most at age 2.
- No trials compare PPV ligation to non-operative management.
Conclusions:
- The natural history of hydrocele post-2 years requires further documentation.
- Current practice lacks strong evidence; delaying surgery may be beneficial.
- A prospective study is needed to assess delayed PPV ligation outcomes.
Background:
There is little consensus over the optimal timing of ligation of a patent processus vaginalis (PPV) in boys with hydrocele. We hypothesized that a proportion of procedures may be unnecessary because they are performed at an age before which the PPV may be expected to close spontaneously. Such excess may expose the child to unnecessary surgery and have significant cost implications.
Methods:
A systematic literature review relating to timing of PPV ligation and a population-based study to define number of PPV ligations performed annually in England and age at surgery were conducted.
Results:
Most hydroceles resolve before 2 years of age, but their natural history beyond this age is poorly documented. Current guidelines recommend PPV ligation at 2 years of age. An average of 2878 operations for hydrocele is performed per year in children in England. Commonest age at repair is 2 years. There are no randomized controlled trials comparing PPV ligation with an observational nonoperative approach.
Conclusions:
The natural history of hydrocele is poorly documented beyond the age of 2 years. There is no good evidence to support current practice. Delaying surgery may reduce the number of procedures necessary without increasing morbidity. A prospective study to investigate this is warranted.
