Abstract/Text
Repair of abdominoscrotal hydrocele is surgically demanding and may be associated with complications. Herein we describe a surgical technique with laparoscopic assisted approach. A 6-month boy with right hydrocele and left absent testis was surgically treated with scrotal approach using one laparoscopic port. In the presence of abdominoscrotal hydrocele and contralateral absent testis, we opted to correct the hydrocele while minimally mobilizing the solitary testis cord and blood vessels. The patient had minimal drainage-postoperatively, he developed fever and was treated with antibiotics. Abdominoscrotal hydrocele in infancy may simply and successfully be treated via scrotal approach with the assistance of one-port laparoscopy (Video).
Copyright © 2016 Elsevier Inc. All rights reserved.
Abstract/Text
PURPOSE: The recommended approach for repairing hydrocele in children is inguinal to address a patent processus vaginalis. Hydrocele repair in adults is performed with a scrotal incision. We identified an age above which a significant percent of children had noncommunicating hydroceles, justifying a scrotal approach.
MATERIALS AND METHODS: A retrospective chart review was performed of children undergoing hydrocele repair at our institution between 1998 and 2006. Operative reports were reviewed by 2 investigators and intraoperative findings were recorded for statistical analysis relating age and findings at the time of the procedure using logistic regression and ROC analysis. Laterality and recurrence rates were also noted.
RESULTS: In this retrospective chart review 82.1% of hydroceles in children older than 10 years had intraoperative findings consistent with noncommunicating hydrocele and 86.4% in children older than 12 years were noncommunicating. One hydrocele in the age group older than 12 years was communicating and the history was suggestive of communication. Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001).
CONCLUSIONS: It is possible in children older than 12 years to repair hydroceles through a scrotal incision unless the clinical history is suggestive of a communication. Children younger than 12 years should undergo inguinal exploration for hydrocele repair.
Abstract/Text
Abdominoscrotal hydrocele (ASH) is an unusual condition characterized by a large scrotal hydrocele which communicates in an hourglass fashion with an abdominal component through the inguinal canal. Based on previous clinical observations, we believed that ASH is a condition that begins as a large scrotal hydrocele during the neonatal period and later expands first into the inguinal canal and finally into the abdominal cavity during the next few months of life. We report a case series of ASH and point out its distinctive characteristics.
Abstract/Text
Abdominoscrotal hydrocele (ASH) in infancy is a rarely reported condition. We present an 11-week-old infant who was born with massive scrotal enlargement. At exploration, he was found to have large bilateral ASHs and bilateral fusiform testes. Gross morphologic testicular changes associated with hydrocele have previously only been reported in adults. Our patient is the youngest to be reported with ASHs.
Abstract/Text
PURPOSE: The scrotal approach to repairing inguinal hernias and hydroceles in boys is a relatively new approach, which offers the paediatric surgeon the choice of leaving a more cosmetically acceptable scar. This paper reports the experience of one centre using this approach.
METHODS: 195 consecutive repairs in 176 boys were studied. The operative technique is described.
RESULTS: With an average follow-up of 13 months, there was one recurrence. There were no wound infections. Testicular size was equal or larger than the contralateral testicle in all but two cases. All boys had an excellent cosmetic result.
CONCLUSION: The scrotal approach for inguinal hernia or hydrocele repair is a safe procedure without added morbidity and with excellent cosmetic results.
Abstract/Text
The popular incision for surgical approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Yet alternative incisions may be considered. A prospectively randomized study of a consecutive series of 256 male infants and children with various inguinal pathologies (mainly indirect inguinal hernias) were treated surgically using the "high trans-scrotal skin-crease incision," over a period of 84 months (7 years) and were compared and found to be clinically better than age- and sex-matched 278 controls with suprapubic transverse inguinal incisions for wound healing/infection, edema, seroma, hematoma, malpositioning or atrophy of testes and recurrence of the primary pathology. The results in the study group were cosmetically and clinically more favorable, and better than the control group. Nosocomial infections, complications of incarceration, and emergency surgery have resulted in an acceptable morbidity rate of approximately 5%. Popularized use of the high trans-scrotal incision and further clinical experience is recommended to facilitate even better results.
Abstract/Text
PURPOSE: This series prospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair.
METHODS: A total of 712 inguinal hernias were corrected laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). The internal inguinal ring was closed with a 4-0 nonabsorbable suture using 2-mm instruments. Patients were prospectively video-documented.
RESULTS: There were no serious intraoperative complications. Operating time was comparable to open surgery. The contralateral inner ring was open on the left side in 16% of boys and 12% of girls, and on the right side in 18% of boys and 32% of girls. Direct hernias were found in 2.3%, femoral hernias in 1%, hernias en pantalon in 0.7%, and a combination of indirect and femoral hernia in 0.2%. Follow-up to date is 1-84 months (median 39 months). There were 4.1% hernia recurrences, 0.7% hydroceles and 0.2% testicular atrophies. Cosmesis is excellent.
CONCLUSIONS: Laparoscopic inguinal hernia repair can be a routine procedure with results comparable to those of open procedures. It is well suited for recurrences. The vas remains untouched. The visualization of structures is clear and leads to a defect-specific closure. The advantages of the laparoscopic approach include the following: its technical ease, it is an outpatient procedure, the cord structures remain untouched, the type of hernia is obvious, trocar placement is identical for any side or hernia type, clear visualization of the anatomy. Routine video documentation renders the diagnostic accuracy objective and absolute. Finally, recurrences are easier dealt with, be it from a previous open or from a laparoscopic approach. Although recurrences were slightly more frequent in the early stages, now they are closer to the rate with the open procedure.
Abstract/Text
BACKGROUND/PURPOSE: In 1995, we developed laparoscopic percutaneous extraperitoneal closure (LPEC) to treat inguinal hernias in children. This study evaluated LPEC's safety, efficacy, and reliability in 3 hospitals.
METHODS: In 2 hospitals, LPEC was the standard procedure used to repair inguinal hernias in children, and in 1 hospital, it was done optionally in girls. During LPEC, a 4.5-mm laparoscope was placed through an umbilical incision, a 2-mm grasping forceps was inserted on the left side of the umbilicus, and a 19-gauge LPEC needle with suture material was inserted at the midpoint of the right or left inguinal line. The hernial sac orifice was closed extraperitoneally by circuit suturing around the internal inguinal ring using the LPEC needle.
RESULTS: Nine hundred seventy-two LPECs were performed on 711 children (age range, 18 days to 19 years): 384 boys had 500 internal inguinal rings closed and 327 girls had 472 internal inguinal rings closed. Operating time for uni- or bilateral inguinal hernias ranged from 10 to 30 minutes. No complications occurred during surgery. The recurrence rate was 0.73% during follow-up (range, 5 months to 10 years). No hydroceles or testicular atrophy occurred after surgery.
CONCLUSION: Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children appears to be safe, effective, and reliable.
Jorge Rioja, Francisco M Sánchez-Margallo, Jesús Usón, Luis A Rioja
Adult hydrocele and spermatocele.
BJU Int. 2011 Jun;107(11):1852-64. doi: 10.1111/j.1464-410X.2011.10353.x.
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