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BOB in Ped Surg 2023 - WOFAPS Winner - Tran Ngoc Son, MD
hosted by Dr. Em Gootee & Dr. Todd Ponsky
Chapter 1 of 3 · Case-Based Learning
WOFAPS presentations
Introduction and presentation of three WOFAPS award winners with audience voting
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Most neonatal hydroceles have some kind of access to the peritoneal cavity; they may seal off with a flutter valve so fluid cannot be pushed back up.
Hydroceles of the cord are different from other hydroceles and do not necessarily communicate with the peritoneal cavity.
Hydroceles of the cord will not necessarily need ligation of the processus vaginalis but really decompression of the cord.
If a hydrocele recurs after treatment, there may be a patent processus vaginalis that was still open even if it was very small and not clearly visualized.
Dr. Rachel Livergant's study was a review and meta-analysis of 14 studies assessing inequities between surgical outcomes in pediatric indigenous and non-indigenous people on American and Oceanic continents regarding post-operative complications, morbidities and mortality.
Dr. Rustan Yuldachev's study examined the relationship between angiographic patterns of extra-hepatic portal vein obstruction and its etiology and clinical manifestations in children with extra-hepatic portal hypertension.
Dr. Tran Ngoc Son's prospective study between June 2016 and December 2021 examined the feasibility and effectiveness of laparoscopic approach for patent processus vaginalis without hydrocelectomy for treating hydroceles.
The traditional hydrocele repair is open repair with an incision, ligating the patent processus vaginalis and performing hydrocelectomy, which can be total or partial excision.
Laparoscopic surgery is increasingly used in treatment of pediatric inguinal hernia but not yet popular in treatment of hydrocele.
In the SILPEC procedure, the patent processus vaginalis was closed extraperitoneally at the internal ring with a 2-0 suture using a percutaneous needle with a wide lasso, without performing hydrocelectomy or plication of hydrocele.
The hydrocele fluid was pushed back to the peritoneal cavity via internal ring before closure of patent processus vaginalis by external manual pressing, and if this was unsuccessful, the fluid was evacuated by percutaneous needle puncture.
553 patients were enrolled with median age of 34 months, ranging from 2 years to 14 years.
Bilateral patent processus vaginalis was found in all patients, and in nearly 30% there was no obvious communication between the hydrocele and the peritoneal cavity.
The median operative time was 17 minutes and median post-operative stay was one day.
There were no major complications and at follow-up of 41 months, the recurrence rate was 0.36%.
Meta-analysis showed that laparoscopic surgery has advantages of less trauma, reduced post-operative pain, faster recovery, improved cosmetics and fewer complications than conventional open surgery, with the advantage of ability for exploration of the contralateral internal ring.
Simple puncture and fluid aspiration alone is ineffective in the management of hydrocele.
In cases where hydrocele has no obvious connection with peritoneal cavity, there is still a discrete one-way passage of fluid towards the scrotum but not the opposite.
The fluid in primary hydrocele is actually peritoneal fluid, not fluid produced by the hydrocele itself, so there is no need for hydrocelectomy.
Laparoscopic management of pediatric hydrocele without hydrocelectomy had comparable outcomes in terms of recurrence compared to other reports with hydrocelectomy.
Bilateral patent processus vaginalis was present in all cases with primary hydrocele in this series.
There are two etiologies for hydroceles: either an opening with fluid going in, or in non-communicating hydroceles there is either a micro-hole or a secretory lining producing fluid.