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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

Journal of Pediatric Surgery
|December 14, 2011
PubMed
Summary

Many hydrocele surgeries in boys may be unnecessary. Delaying patent processus vaginalis (PPV) ligation could reduce procedures without increasing harm, warranting further study.

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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.

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  • 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.