Inguinal hernia and hydrocele

Abstract

Inguinal hernia and hydrocele in childhood result from incomplete closure of the patent processus vaginalis. Differentiation between the two conditions is important because management differs markedly. An inguinal hernia is intermittently present, becoming more obvious on straining or crying; a hydrocele is a more constant swelling that usually transilluminates. Inguinal herniae are at significant risk of incarceration (particularly in younger babies) and may warrant early surgery. Hydroceles usually resolve spontaneously during the first years of life and surgery may be delayed until three years of age. Incarceration of an inguinal hernia presents with pain, erythema and later with signs of intestinal obstruction. Reduction of the mass should be attempted; failure prompts urgent transfer to a specialist paediatric surgical unit. Surgical technique is similar for hernia and hydrocele. Repair of an incarcerated is challenging, with a high risk of damage to the vas deferens and testicular vessels. Complications may result from incarceration, with consequent damage to bowel or testicular vessels. Operatively, the most significant complications are recurrence (about 4%) and testicular atrophy (about 6%). Exploration of the contralateral inguinal region during unilateral herniotomy is controversial. The incidence of a metanchronous contralateral hernia is <10%; reserve prospective exploration for those at increased risk