Abstract
PurposeTo 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.MethodsThe 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.ResultsThe 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.ConclusionLaparoscopic 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.
Highlights
Infantile hydrocele is an abnormal collection of fluid along the course of the processus vaginalis due to incomplete obliteration
The occurrence of infantile hydrocele is related to the descent of the testis, as it passes through the internal ring, it pulls along a diverticulum of peritoneum on its anteromedial surface referred to as “the processus vaginalis” [1]
As regard to the laparoscopic shape of the internal inguinal ring (IIR) on the same side, we found that the IIR was patent (Type II and III) in 97 hydroceles (91.5%) (Figs. 3 and 4) (Table 1)
Summary
Infantile hydrocele is an abnormal collection of fluid along the course of the processus vaginalis due to incomplete obliteration. The occurrence of infantile hydrocele is related to the descent of the testis, as it passes through the internal ring, it pulls along a diverticulum of peritoneum on its anteromedial surface referred to as “the processus vaginalis” [1]. Persistent patent processus vaginalis (PPV) is a common cause of hydrocele in children and explains approximately 60% of the cases in infants. Closure of the PPV may be the most effective in preventing the recurrence [2]. Laparoscopic closure of the internal orifice of the PPV became an option for the treatment of hydroceles in children [4]
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