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Hydrocele
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Sac resection can alternatively be performed with hook cautery, but requires maintaining safe distance from vas deferens and cord vessels to avoid thermal spray injury. — Todd Ponsky, Laparoscopic Hydrocele Repair Technique · 2:25
Laparoscopic Hydrocele Repair Technique
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This is a Technique Video That shows a laparoscopic repair of a hydrocele by Dr. Todd Ponsky
Narrator: Dr. Cecilia Gigena
video4:39 · Apr 2024
The Hill-Snow procedure (a PEXI) may have questionable benefit compared to Lap Nissen, and benefit may depend on the type of PEXI, as other PEXI studies have not shown benefit — Todd Ponsky, BOB in Ped Surg 2023 - OVERALL WINNER - Dr. Rebeca Figueira - EUPSA · 1:33
BOB in Ped Surg 2023 - OVERALL WINNER - Dr. Rebeca Figueira - EUPSA
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The overall winner of the Best of the Best in Pediatric Surgery 2023 is Dr. Rebeca Figueira of EUPSA on her presentation of "Fetal lung vascular development is reduced by amniotic fluid stem cells extracelullar vesicles in experimental cong
video6:28 · Feb 2023
Toddlers recover from surgery with less morbidity and fewer psychological effects than older children (6-7 years) who associate hospital stays with missing school. — Sharif, Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery... · 13:30
Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, Dr. Cristobal Abello Munarriz introduceslaparoscopic epigastric herniorrhaphy, narrated in English by Dr. Todd Pon
video14:58 · Sep 2018
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Expert statements from the recordings in this collection.
Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...
The case involved a 5-year-old girl with epigastric swelling and tenderness that had not reduced for 6 months.
Host summaryThe host summarizing a resource — not the host's own clinical position0:00 ↗
The technique used a 3mm umbilical port and 3mm percutaneous instruments in the left anterior axillary line.
Host summaryThe host summarizing a resource — not the host's own clinical position0:30 ↗
Finger pressure on the abdominal wall hernia bulge was used to identify the hernia site laparoscopically.
Host summaryThe host summarizing a resource — not the host's own clinical position1:00 ↗
The peritoneum was opened, fatty tissue removed, and the hernia ring exposed and closed with interrupted percutaneous 3-0 PDS sutures.
Host summaryThe host summarizing a resource — not the host's own clinical position1:30 ↗
The laparoscopic approach avoids a non-cosmetic incision and scar in the epigastric region.
Host summaryThe host summarizing a resource — not the host's own clinical position2:20 ↗
Combined optics with a working channel allow repair through the umbilicus alone, using endoclose or percutaneous sutures tied subcutaneously.
clinical2:58 ↗
True epigastric hernias contain only preperitoneal fat and are extraperitoneal, not full-thickness defects with omentum or peritoneal sac.
clinicalSharif3:35 ↗
Working on the anterior abdominal wall through the umbilicus is difficult due to poor working angle.
opinionSharif4:00 ↗
Dr. Abello confirmed the hernia was a true epigastric hernia with fat, not omentum.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position4:34 ↗
The surgeon opened the peritoneum from inside, accessed the preperitoneal space, and pulled down preperitoneal fat that was residing in the hernia space.
clinical4:43 ↗
Finger pressure on the outside pushed the hernia contents inward to aid laparoscopic identification.
clinicalKathy5:06 ↗
For teenage girls with unsightly epigastric hernias, the laparoscopic technique is worth considering for cosmetic reasons.
opinionKathy5:06 ↗
Some small epigastric hernias in 3-4 year olds enlarge significantly by age 10, with increased preperitoneal fat and larger defects.
clinicalSharif5:31 ↗
The natural history of epigastric hernias is to enlarge over time.
clinicalSharif5:55 ↗
Repairing epigastric hernias when small is a minor procedure.
opinionSharif5:55 ↗
Asymptomatic epigastric hernias may enlarge into adulthood, especially after pregnancy in females, potentially requiring mesh rather than primary closure.
clinicalTodd Ponsky6:01 ↗
Many epigastric hernias remain totally asymptomatic and small in size throughout life.
clinicalJeff6:34 ↗
Epigastric hernias are not a significant health concern like inguinal hernias.
opinionJeff7:00 ↗
Some women with epigastric hernias experience significant pain during pregnancy.
clinicalJeff7:10 ↗
Inferior epigastric hernias can be repaired through a periumbilical incision by moving the skin incision upward.
clinicalKathy7:23 ↗
Dr. Abello does not repair all asymptomatic epigastric hernias but does repair them in female patients due to pregnancy concerns.
Host summaryThe host summarizing the discussion — not the host's own clinical position7:49 ↗
Some large adult epigastric hernias require mesh repair.
clinicalTodd Ponsky7:57 ↗
Oliver Munster presented the same laparoscopic technique at IPEG in Beijing.
clinicalTodd Ponsky8:40 ↗
Scars in young children grow proportionally as the child grows.
clinicalTodd Ponsky8:50 ↗
Hiding the scar in the umbilicus offers a cosmetic advantage over midline epigastric scars.
opinionTodd Ponsky8:55 ↗
A supraumbilical or periumbilical incision can reach epigastric hernias located halfway to the xiphoid process, based on experience with pyloric stenosis operations.
clinicalTodd Ponsky9:30 ↗
Some abdominal wall hernias 1-1.5 cm above the umbilicus are full-thickness defects with a peritoneal sac, not true epigastric hernias, and may be misdiagnosed.
clinicalSharif10:20 ↗
Multiple small abdominal wall defects (Swiss cheese pattern) can occur in the epigastric region.
clinicalSharif10:55 ↗
Supraumbilical hernias (1 cm above the umbilicus) can be repaired through a supraumbilical incision hidden in the umbilicus.
clinicalKathy11:01 ↗
Epigastric hernias located midway between xiphoid and umbilicus in children over 1 year are difficult to reach through an umbilical or supraumbilical incision.
clinicalKathy11:30 ↗
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