Pediatric Hydrocele Research Articles

Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele.

Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV). The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR). A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups. PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.

Comparison of the results of open repair and laparoscopic repair with the PIRS method in the treatment of hydrocele in children.

Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center. We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed. The data of 113 patients (OR 58.4% (n = 66), LR 41.6% (n = 47)) were collected. In preoperative examination, 12.4% (n = 14) patients were diagnosed as communicating and 87.6% (n = 99) non-communicating hydrocele. Intraoperatively, 65.5% (n = 74) patients were communicating and 34.5% (n = 39) were non-communicating. Total recurrence rate was 7% (n = 8). The OR group experienced a recurrence rate of 10.6% (n = 7), while the LR group experienced 2.12% (n = 1). Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.

Laparoscopic Excision of Patent Processus Vaginalis for Pediatric Hydroceles.

BackgroundThe standard surgical practice for pediatric hydrocele is resection and ligation of the patent processus vaginalis (PPV). Non-ligation of PPV for pediatric hydrocele is another possibility that can be repaired laparoscopically.Material & methodsA retrospective study was undertaken over 10 years (Jan 2011-Feb 2020), of a case series of boys with hydroceles that underwent laparoscopic PPV (Lap PPV) excision. Exclusion criteria were for parents who requested open surgery (10 cases) or an omental plug noted at the PPV site during laparoscopy (one case). Laparoscopic PPV excision was performed via a transperitoneal approach.ResultsThere were 43 cases of Lap PP excision, including three recurrences after open surgery. There were no conversions, complications, or recurrences in any patients. The average operative time for unilateral cases was 21 mins (range 15-30 mins). Three concurrent contra-lateral hydroceles were noted and resected during the primary procedure. Time to regular activity was within one day. There was no visible scar or recurrence after Lap PPV at six months post-surgery review.ConclusionLap PPV excision appears to be at least equivalent to the “open and ligation” approach. During laparoscopy, both internal rings are assessed for a PPV.By avoiding an inguinal incision(s), a better cosmetic result is possible. It is conceivably safer than open surgery in recurrent cases.

Trends in treatment outcomes of hydrocele in Japanese children: A single-institute experience.

To investigate trends in treatment outcomes of surgical intervention versus observation for pediatric hydrocele. This retrospective study included 175 patients diagnosed with hydrocele at our institution. Hydrocele was diagnosed based on medical history, physical examination and ultrasonography findings. The treatment for these patients was divided into two options: surgical intervention or careful follow up; the outcomes were investigated. The median age at diagnosis was 3months, and a total of 11 patients (6%) were premature at birth. Hydrocele was diagnosed on the right side, the left side and bilaterally in 106 (61%), 46 (26%) and 23 (13%) patients, respectively. A total of 136 patients showed spontaneous improvement at the median 7months after diagnosis, and 54 patients underwent surgical intervention. The rate of spontaneous resolution deceased with age, but spontaneous resolution was observed in patients aged >2years. Our findings suggest that spontaneous resolution can be observed in patients aged >2years, and surgical intervention can be carried out effectively and safely. Infant hydrocele should be followed up carefully for at least 1year without surgical intervention since diagnosis. Investigation of the optimal timing of and appropriate reason for surgical intervention can lead to better management and outcomes in patients with hydrocele. Further research is warranted to support the current clinical practice.

Updated clinical results of laparoscopic treatment of pediatric hydrocele; 5 year of follow-up

Updated clinical results of laparoscopic treatment of pediatric hydrocele; 5 year of follow-up

Effectiveness of Laparoscopy in the Treatment of Pediatric Hydrocele: A Systematic Review

Objective: To conduct a systematic review of the published studies concerning laparoscopic pediatric hydrocele (PH) repair and summarize the surgical details and operative outcomes of this procedure. Materials and Methods: A PubMed search was performed for all studies concerning laparoscopic repair of hydrocele in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND hydrocele* AND (child* OR pediatric*). Inclusion criteria included (1) children with hydrocele as the study participant; (2) laparoscopic PH repair as the main surgical procedure; and (3) operation time and complications as the outcomes of interest. Reviews, studies with insufficient information or reporting the outcomes of abdominoscrotal hydrocele, and duplicate patient series were excluded. Results: Overall, 20 studies fulfilled the inclusion criteria of this review and 15 studies were included in the final analysis. These studies comprised at least 2920 patients undergoing laparoscopic repair for various PH subtypes, of which most were conducted in Asia. Most authors repaired PH laparoscopically through an extraperitoneal approach, while only a few studies applied a laparoscopic intraperitoneal method. The majority of the studies used nonabsorbable sutures to ligate hydrocele sac, while very few studies used absorbable materials. Hydrocele sac was resected or transected in only five studies, but left alone in the majority. Mean operation time was between 15.6 and 43.2 minutes for unilateral laparoscopic PH repair and between 16.9 and 53.2 minutes for bilateral surgery. Operative complications were not very common, with a highest recurrence/persistence incidence of 1.4%. Subgroup analysis showed that hydrocele subtype, surgical approach, suture material, and management of hydrocele sac did not significantly influence the operative complications. Conclusions: laparoscopic PH repair seems to be a safe and effective procedure. Given the limitations of this review, our conclusion needs to be confirmed by more well-designed studies.

Is two-port laparoendoscopic single-site surgery (T-LESS) feasible for pediatric hydroceles? Single-center experience with the initial 59 cases

Although T-LESS is increasingly being used to treat pediatric inguinal hernia, there is no study regarding T-LESS for pediatric hydrocele. To further evaluate the feasibility of T-LESS and present our single-center experience for repair of pediatric hydroceles. From January 2016 to July 2016, all boys undergoing T-LESS for hydrocele in our institute were retrospectively reviewed. A laparoscope and a needle-holding forceps were introduced at umbilicus. A round needle with silk suture was stabbed through the abdominal wall. The peritoneum around the internal ring was sutured continuously in a clockwise direction. After a complete purse-string suture, a triple knot was performed by using a single-instrument tie technique. The contralateral patent processus vaginalis (PPV) was repaired simultaneously if present. Overall, 59 boys with hydrocele were included (22 on the left side, 32 on the right side, and 5 bilaterally) (Table). During the procedure, all hydroceles were observed with a PPV but the fluid needed to be aspired in 39 boys. A contralateral PPV was present in 24 boys with unilateral hydrocele, and finally 88 repairs were performed. Mean operative time was 18.3min for unilateral repair and 27.5min for bilateral repair, respectively. All procedures were uneventful besides a minor injury to the inferior epigastric vessels. After a mean follow-up of 10.7 months, neither recurrence nor other postoperative complication was observed. There were no visible scars on the abdominal wall. Compared with open repair of pediatric inguinal hernia and hydrocele, laparoscopic surgery had several advantages, such as exploration of contralateral PPV, identification of rare hernias, diminished postoperative pain, improved cosmesis, faster recovery, and fewer complications. Differing from the laparoscopic retroperitoneal approach, T-LESS included no subcutaneous tissue in the ligature, and its knot was completely in the peritoneal cavity which could radically prevent the severe pain and suture granuloma in the ligated region. Furthermore, the skin incisions after T-LESS were hidden in umbilicus, which could achieve an excellent cosmetic result. By performing T-LESS for pediatric hydroceles, the current study showed very satisfactory results, such as high success rate, minor complication, and excellent cosmesis. However, because of the difficult learning curve of T-LESS, some technical details (e.g. avoiding injury to the spermatic cord, completely suturing the peritoneal folds and reducing disturbance between the instruments) still need to be improved in the future. T-LESS appears to be a safe and effective method for repair of pediatric hydroceles.

Ten year experience of laparoscopic repair of pediatric hydrocele and the long-term follow-up results.

This study aims to assess the efficacy and safety of laparoscopic repair for pediatric hydroceles and its long-term follow-up results. We performed this procedure to 284 patients from 2002 to 2011 using our specially designed curved awl. The patent internal ring was enclosed and fixed under laparoscopy and fluid within the patent processus vaginalis was emptied by percutaneous needle aspiration. The median operation time was 16minutes. Fifty-seven contralateral open internal rings were diagnosed during laparoscopic exploration and closed at the same time. During our 10-year follow-up only four kids had recurrence of moderate amount of fluid accumulation 1-3months after the surgery and 3 of them spontaneously resolved during the outpatient follow-ups. Only one of them was treated by percutaneous needle aspiration successfully. No abdominal viscera injury happened. Laparoscopic hydrocele repair proved to be applicable and effective with satisfactory long-term results according to our experience.

Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience

To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in the hydrocele sac orifice. A total of 125 consecutive cases of boys with unilateral pediatric hydrocele underwent minilaparoscopic repair between June 2008 and June 2013. The patients were divided into 2 groups. Group 1 consisted of 65 patients who underwent a 2-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. Group 2 included 60 patients who received a modified single-port, double-needle, minilaparoscopic surgery. An Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing in group 2. The principal outcome factors were assessed between the groups. A total of 151 minilaparoscopic procedures were performed in 125 patients (age range, 12-68 months; median, 21.5 months). In total, 26 extra procedures were performed for simultaneous repair of a potential contralateral patent processus vaginalis. No significant difference in operation time was noted between group 1 and group 2 (25.9 ± 6.4 vs 27.1 ± 5.5 minutes). The procedures were performed successfully without serious preoperative complications. During a median follow-up period of 18 months (range, 6-36 months), no postoperative hydrocele recurrence was encountered. Our limited experience suggests that the modified single-port, double-needle, minilaparoscopic technique could be safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles.

Modified single-port minilaparoscopic extraperitoneal repair for pediatric hydrocele: a single-center experience with 279 surgeries

The purpose of the study is to introduce our experience of a modified single-port minilaparoscopic technique for the treatment of pediatric hydrocele. Between June 2008 and May 2012, 279 boys (115 communicating hydrocele and 164 "non-communicating" hydrocele, diagnosis based on preoperative physical examination and scrotal ultrasound) underwent the modified single-port minilaparoscopic repair in our institution. During surgery, a 3-mm laparoscope was inserted into the abdomen through a mini-umbilical incision. The hydrocele sac orifice was closed by an extraperitoneal purse-string suture placed around the internal ring with an ordinary taper needle and an endoclose needle. Of all the 279 patients, 16 (5.7 %) were found to have a potential patent processus vaginalis (PPV) on the contralateral side. Of the 164 boys diagnosed with "non-communicating" hydrocele preoperatively, 5 (3.0 %) had no PPV identified in laparoscope and the other 159 (97.0 %) had PPV actually. A total of 274 single-port minilaparoscopic procedures were performed, and all cases were successful without serious complications. The mean operative time was 19.5 and 24.8 min for unilateral and bilateral operations, respectively. Postoperative complications were noted in 4 cases, 2 (0.7 %) patients with scrotal edema, 1 (0.4 %) patient experienced an umbilical hernia, and 1 (0.4 %) patient with suture site abscess. During a median follow-up period of 9 months (range 6-24 months), postoperative hydrocele recurrence was seen in 2 patients (0.7 %). This modified single-port minilaparoscopic technique is a safe, effective, and reliable procedure for pediatric hydroceles.

Laparoscopic Extraperitoneal Repair of Symptomatic Hydrocele in Children: A Single-Center Experience with 73 Surgeries

To introduce a novel, two-port laparoscopic technique for treatment of hydrocele in children, which allows completely extraperitoneal closure of the patent processus vaginalis (PPV) and does not necessitate laparoscopic suturing skills. We describe a consecutive series of 56 boys with a median age of 36 months (range 12-144 mos) who presented with a presumably communicating hydrocele. Laparoscopic repair of these hydroceles was performed between July 2009 and June 2010. During surgery, a 5-mm laparoscope and a 3-mm grasping forceps were inserted through an identical umbilical incision (10 mm). The hydrocele sac orifice was closed extraperitoneally by circuit suturing around the internal inguinal ring. All cases were preoperatively diagnosed to be unilaterally based on physical examination and ultrasonography. During surgery, 17 of the 56 (30%) patients presented a contralateral PPV. A total of 73 laparoscopic procedures were achieved, with a success rate of 100%. The mean operative time was 25±6 and 36±5 minutes for unilateral and bilateral operations, respectively. During a median follow-up period of 6 months (range 1-12 mos), neither recurrence nor other postoperative complication was encountered. Our limited experiences suggest that the two-port, totally extraperitoneal laparoscopic technique could be a safe, effective, and reliable alternative for management of pediatric hydrocele.

Minilaparoscopic High-ligation With the Processus Vaginalis Undissected and Left In Situ is a Safe, Effective, and Durable Treatment for Pediatric Hydrocele

We report our experience of minilaparoscopy in the treatment of pediatric hydrocele. Between 2003 and 2007, a total of 21 male infants or children with 22 hydroceles underwent minilaparoscopic surgery at our institute. The patent processus vaginalis (PPV) was detached from the adjacent peritoneum by circumferentially incising the peritoneum (opening of PPV) at the internal ring. The opened peritoneum was closed with suture, with the PPV left in situ. Contralateral PPV, if present, was simultaneously treated in the same manner. All received a periodical follow-up with physical examinations and scrotal sonography. The median age was 43 months (13-163 months). The median operative time was 50 minutes (29-105 minutes). On the side of hydrocele, the median length of the PPV was 5.0 cm (2.0-10.0 cm). Contralateral asymptomatic PPV was found in 6 (30.0%) of the 20 patients with unilateral hydrocele, with a median length of 2.0 cm (1.0-4.0 cm). All postoperative courses were uneventful without any complication. After a median follow-up of 46 months (13-59 months), none had ipsilateral recurrence or metachronous contralateral occurrence of hydrocele or hernia, and none suffered from testicular atrophy or chronic wound pain. Based on a long-term follow-up, our data show that minilaparoscopic high-ligation with the PPV undissected and left in situ is a safe, effective, and durable treatment for pediatric hydrocele. The contralateral PPV, if present, can be treated simultaneously to prevent metachronous contralateral occurrence of hydrocele or hernia.

Indication for surgery of pediatric testicular and funicular hydroceles in view of natural course

The purpose of this study is to confirm the definite indication for surgery of pediatric testicular and funicular hydroceles in view of natural course. During the period from 1978 to 1994, we encountered 160 hydroceles in 149 pediatric patients. Patients ages ranged from 5 days after birth to 13 years and the mean follow-up periods was 4.7 years. We investigated the indication for surgery of pediatric hydroceles in six points of view: value of an aspiration of hydroceles, of what testicular or funicular or both, communication, size, age and testicular development. Nevertheless, of 160 hydroceles, 66 (41%) were performed an aspiration of hydroceles, the aspiration of hydrocele was ineffective in the majority of patients. Common hydroceles in neonates and infants required no specific treatment, as the majority of hydrocele resolve spontaneously, however surgical treatment was required for a communicating large hydrocele that had been often attacked by aspiration and appeared at older age. Funicular hydroceles were more difficult to spontaneous healing. Ipsilateral testis manifests a well-developed comparing control material. The indication for surgery of pediatric hydroceles were as follows: 1) hydroceles complicated by a inguinal hernia or cryptorchidism, 2) hydroceles appeared at older age and not resolved during 2-3 years over, 3) giant communicating funicular and testicular hydroceles present with an/hindrance for daily life.

The Value of the Aspiration of Pediatric Hydroceles

The Value of the Aspiration of Pediatric Hydroceles

A new technique for the repair of pediatric hydroceles.

The major difficulties encountered in the surgical correction of pediatric communicating hydroceles are separating the hernial sac from the spermatic vessels and vas, and identifying the anatomical location of the internal inguinal ring. The passage of a pediatric Foley catheter through the hernial sac via a high scrotal incision greatly expedites this surgery. Herein, we describe a new surgical technique and discuss its merits.