Is external oblique aponeurosis incision necessary in pediatric hydrocelectomy? A large retrospective cohort study

Pediatric inguinal hydrocele repair often includes incision of the external oblique aponeurosis, although its necessity remains unclear. This study compared recurrence and operative time after repair with and without aponeurosis incision.

We retrospectively reviewed 758 boys who underwent open inguinal pediatric hydrocele repair between November 2021 and January 2026. The primary outcome was recurrence. A 1:1 propensity score-matched analysis was performed to reduce measured baseline imbalance.

Of 758 patients, 485 underwent repair without aponeurosis incision and 273 with incision. Recurrence occurred in 8 and 6 patients, respectively (1.6% vs. 2.2%, p = 0.585). After matching, 231 patients were included in each group; recurrence occurred in 4 non-incision and 5 incision patients, with no significant paired difference (exact McNemar p = 1.000). Operative time remained shorter without incision in the matched cohort (25.8 ± 4.3 vs. 33.5 ± 5.9 min, p < 0.001).

In this retrospective cohort, we did not detect a statistically significant difference in recurrence between techniques; however, the study was not designed or powered to establish non-inferiority. The non-incision approach was associated with shorter operative time.