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Laparoscopic management of infantile hydrocele in pediatric age group
Ahmed Elhaddad1, Mohamed Awad1, Sherif M Shehata1
1Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, Egypt, El-Geish Street, Tanta, 31527, Egypt.
Insights
Laparoscopic hydrocelectomy is a safe and effective pediatric procedure. The internal inguinal ring (IIR) is typically patent, and managing the contralateral IIR simultaneously can prevent recurrence.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Urology
Background:
- Hydroceles are common in pediatrics.
- The processus vaginalis (PPV) plays a role in hydrocele formation.
- Understanding internal inguinal ring (IIR) status is crucial for management.
Observation:
- 93 pediatric patients with 106 infantile hydroceles were evaluated.
- Internal inguinal ring (IIR) patency was assessed on ipsilateral and contralateral sides.
- Laparoscopic management was performed for various hydrocele types.
Findings:
- The IIR was patent in 91.5% of ipsilateral cases (Type II and III) and 88.7% of contralateral cases.
- Laparoscopic hydrocelectomy demonstrated a zero conversion rate and no intra-operative complications.
- Post-operative complications were minimal, with one case of scrotal edema managed conservatively.
Implications:
- Laparoscopic hydrocelectomy is a safe and feasible option for pediatric hydroceles.
- IIR patency is common, necessitating evaluation and potential management.
- Simultaneous contralateral IIR management during laparoscopic hydrocelectomy can prevent recurrence.
Purpose:
To evaluate laparoscopic management of hydroceles in pediatrics, with evaluation of the internal inguinal ring (IIR) and the PPV (patent processus vaginalis) in different types of hydroceles, and the incidence of the contralateral PPV.
Methods:
The IIR and the type of hydrocele on the same side of 93 patients with 106 infantile hydroceles were evaluated and managed, in addition to contralateral side.
Results:
The IIR on same side was closed in 8.5% (Type I) and patent in 91.5% (Type II and III) with different shapes. Contralateral IIR was open in 88.7% of cases. The operative time was 30.99 ± 7.23 min, with no intra-operative complication. The vas deferens and testicular vessels were secured and there were no injuries or bleeding. The conversion rate was zero, and all procedures (Type II and II) were completed totally laparoscopic. No post-operative complications except a case of tense hydrocele developed scrotal edema that managed conservatively.
Conclusion:
Laparoscopic hydrocelectomy is safe, applicable and feasible for management of different types of hydroceles in pediatrics. The IIR is patent in nearly all cases with/out communication to the hydrocele. The contralateral IIR can be managed in the same session. Laparoscopic hydrocelectomy with/out hydrocelectomy and IIR closure is essential in preventing recurrence.
