Abdominoscrotal hydrocele: excision of sac may not be necessary

Abdominoscrotal hydroceles (ASH) are uncommon occurrences in boys and usually treated similarly to a hernia with the assumption that there is an associated patent processus vaginalis. Treatment in this manner may be challenging due to sac size, extension and adherence to the spermatic cord. Due to the rarity of ASH, the literature is mostly limited to small, single-institution case studies.

Our goal was to evaluate two techniques in large number. We hypothesized a simplified scrotal technique with eversion, Jaboulay procedure, would demonstrate less complications and equivalent efficacy to standard excision.

We retrospectively reviewed medical records at three tertiary children's hospitals to identify boys who underwent surgical repair of ASH between 1998 and 2018. Group 1 had excision and/or ligation of the hydrocele sac. Group 2 had a scrotal incision with limited excision and then eversion of the hydrocele sac (Jaboulay procedure). Variables that were analyzed included preoperative imaging, surgical technique, surgical findings, length of follow up, complications and recurrence of swelling.

We identified 61 boys, who had 77 abdominoscrotal hydroceles. Group 1 included 38 patients with 48 hydroceles. Group 2 included 23 patients with 29 hydroceles. Complications were more common in Group 1 patients (18% vs 0%) but complication rate and operative time were not statistically associated with surgery type or age. No patient in either group had recurrence of hydrocele.

Although this is a large study for this rare condition, the analysis is limited by number and its retrospective nature.

For the rare and difficult to treat abdominoscrotal hydrocele, we were unable to prove with statistical significance that a simplified technique of eversion via the scrotum is safer. However, this large series did demonstrate that the simplified procedure provides equal efficacy as excision.