BOB Ped Surg 2023 - Tran Ngoc Son, WOFAPs - Presentation

Traditional hydrocele repair is open repair with an incision, high ligation of PPV and hydrocelectomy, which can be total or partial or aspiration.

Laparoscopic surgery is increasingly used in the treatment of pediatric inguinal hernia, but not yet popular in the treatment of hydrocele.

The study was a prospective study on all children with primary hydrocele treated at the center for a 5-year period.

The SIPC procedure uses two ports placed at the same single umbilical incision.

PPV was closed extraperitoneally at the internal inguinal ring with a 2-0 suture using a percutaneous needle.

No hydrocelectomy or penetration of hydrocele was performed in the SIPC technique.

The hydrocele fluid was pushed back to the peritoneal cavity via internal ring before closure of PPV by external manual pressing, and if this step was unsuccessful, the fluid was evacuated by percutaneous needle puncture.

553 patients were enrolled in the study with a median age of 34 months ranging from 2 years to 14 years.

Ipsilateral patent PPV was found in all patients in the study.

In nearly 30% of patients there was no obvious communication between the hydrocele and the peritoneal cavity.

The median operative time was 70 minutes.

The median postoperative stay was 1 day.

There were no major complications in the study.

At a follow-up of 41 months, the recurrence rate was 0.36%.

The postoperative cosmesis was excellent.

Laparoscopic surgery has the advantage of ability for exploration of the contralateral internal inguinal ring.

Simple puncture and fluid aspiration alone is ineffective in the management of hydrocele.

The principles of laparoscopic management of pediatric hydrocele are in controversy, with some authors using closure of PPV and hydrocelectomy or wide fenestration, while others perform high PPV ligation without hydrocelectomy.

Laparoscopic management of pediatric hydrocele without hydrocelectomy had comparable outcomes in terms of recurrence compared to other reports with hydrocelectomy.

In cases where the hydrocele had no obvious connection with the peritoneal cavity, the PPV was still ligated and the fluid in the cyst was evacuated with a percutaneous needle, with no recurrence recorded.

In cases with no obvious communication, there is still a discrete one-way passage of peritoneal fluid towards the scrotum, but not the opposite.

The fluid in primary hydrocele is actually peritoneal fluid, not fluid produced by the hydrocele cyst itself, so there is no need for hydrocelectomy.