Laparoscopic Marsupialization Before Inguinal Repair of Large Abdominoscrotal Hydroceles in Infants: Observation of Natural History and Description of Technique

Abstract

To develop a surgical procedure that would minimize the difficult proximal spermatic cord dissection during excision of the abdominal component of abdominoscrotal hydroceles (ASHs). Because the abdominal component is derived from the peritoneum, we postulated that complete removal of all tissue is unnecessary and laparoscopic creation of a wide peritoneal window is sufficient for treatment before inguinal repair of the scrotal component. We describe a series of 4 patients who underwent laparoscopic marsupialization of the abdominal component of an ASH before inguinal repair. In addition, we describe the natural history of a patient who had had initial normal evaluation of bilateral scrotal hydroceles on ultrasonography and subsequently developed the abdominal portion during the first year after birth. Four patients underwent successful laparoscopic marsupialization of the abdominal component before inguinal repair of the ASH. No postoperative complications occurred, and no patient required repeat operation. Laparoscopic marsupialization of the abdominal portion of an ASH is a practical surgical alternative that may reduce the morbidity of extensive dissection.