Minilaparoscopic high-ligation with the processus vaginalis undissected and left in situ is a safe, effective, and durable treatment for pediatric hydrocele

Abstract

Objectives: We report our experience of minilaparoscopy in the treatment of pediatric hydrocele.

Methods: 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.

Results: 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.

Conclusions: 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.