# Hydrocele — GCMD Library living collection

Everything in the library about hydrocele — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 46 cited statements

## Episodes
### Surgical Management
- [Laparoscopic-assisted Treatment of Abdominoscrotal Hydrocele](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250) — video · 4:35 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250.md)

### Evidence & Research
- [BOB in Ped Surg 2023 - OVERALL WINNER - Dr. Rebeca Figueira - EUPSA](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329) — video · 6:28 · [machine version](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329.md)

### Case-Based Learning
- [Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426) — video · 14:58 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=0) Case presentation: laparoscopic epigastric hernia repair in a 5-year-old (Ep 1)
- [2:41](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=161) Debate on the role of laparoscopy for epigastric hernia repair (Ep 1)
- [5:20](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=320) Natural history and indications for repair of epigastric hernias (Ep 1)
- [10:59](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=659) Age considerations, anesthesia risk, and technical challenges (Ep 1)
- [0:08](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=8) Introduction and Epidemiology of Abdominoscrotal Hydroceles (Ep 2)
- [1:35](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=95) Case Presentation and Physical Examination Findings (Ep 2)
- [2:35](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=155) Pathophysiology and Surgical Anatomy (Ep 2)
- [3:15](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=195) Surgical Technique and Laparoscopic-Assisted Repair (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=0) Introduction of finalists and voting instructions (Ep 3)
- [2:58](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=178) GlobalCast MD promotional video (Ep 3)
- [4:07](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=247) Winner announcement and closing remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Combined optics with a working channel allow repair through the umbilicus alone, using endoclose or percutaneous sutures tied subcutaneously. (clinical) [Ep 1 · 2:58](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=178)
- True epigastric hernias contain only preperitoneal fat and are extraperitoneal, not full-thickness defects with omentum or peritoneal sac. — Sharif (clinical) [Ep 1 · 3:35](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=215)
- Working on the anterior abdominal wall through the umbilicus is difficult due to poor working angle. — Sharif (opinion) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=240)
- The surgeon opened the peritoneum from inside, accessed the preperitoneal space, and pulled down preperitoneal fat that was residing in the hernia space. (clinical) [Ep 1 · 4:43](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=283)
- Finger pressure on the outside pushed the hernia contents inward to aid laparoscopic identification. — Kathy (clinical) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=306)
- For teenage girls with unsightly epigastric hernias, the laparoscopic technique is worth considering for cosmetic reasons. — Kathy (opinion) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=306)
- Some small epigastric hernias in 3-4 year olds enlarge significantly by age 10, with increased preperitoneal fat and larger defects. — Sharif (clinical) [Ep 1 · 5:31](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=331)
- The natural history of epigastric hernias is to enlarge over time. — Sharif (clinical) [Ep 1 · 5:55](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=355)
- Repairing epigastric hernias when small is a minor procedure. — Sharif (opinion) [Ep 1 · 5:55](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=355)
- Asymptomatic epigastric hernias may enlarge into adulthood, especially after pregnancy in females, potentially requiring mesh rather than primary closure. — Todd Ponsky (clinical) [Ep 1 · 6:01](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=361)
- Many epigastric hernias remain totally asymptomatic and small in size throughout life. — Jeff (clinical) [Ep 1 · 6:34](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=394)
- Epigastric hernias are not a significant health concern like inguinal hernias. — Jeff (opinion) [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=420)
- Some women with epigastric hernias experience significant pain during pregnancy. — Jeff (clinical) [Ep 1 · 7:10](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=430)
- Inferior epigastric hernias can be repaired through a periumbilical incision by moving the skin incision upward. — Kathy (clinical) [Ep 1 · 7:23](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=443)
- Some large adult epigastric hernias require mesh repair. — Todd Ponsky (clinical) [Ep 1 · 7:57](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=477)
- Oliver Munster presented the same laparoscopic technique at IPEG in Beijing. — Todd Ponsky (clinical) [Ep 1 · 8:40](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=520)
- Scars in young children grow proportionally as the child grows. — Todd Ponsky (clinical) [Ep 1 · 8:50](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=530)
- Hiding the scar in the umbilicus offers a cosmetic advantage over midline epigastric scars. — Todd Ponsky (opinion) [Ep 1 · 8:55](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=535)
- A supraumbilical or periumbilical incision can reach epigastric hernias located halfway to the xiphoid process, based on experience with pyloric stenosis operations. — Todd Ponsky (clinical) [Ep 1 · 9:30](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=570)
- 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. — Sharif (clinical) [Ep 1 · 10:20](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=620)
- Multiple small abdominal wall defects (Swiss cheese pattern) can occur in the epigastric region. — Sharif (clinical) [Ep 1 · 10:55](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=655)
- Supraumbilical hernias (1 cm above the umbilicus) can be repaired through a supraumbilical incision hidden in the umbilicus. — Kathy (clinical) [Ep 1 · 11:01](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=661)
- Epigastric hernias located midway between xiphoid and umbilicus in children over 1 year are difficult to reach through an umbilical or supraumbilical incision. — Kathy (clinical) [Ep 1 · 11:30](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=690)
- Anesthesiologists are reluctant to anesthetize children under age 5 for truly elective operations due to soft reports of cognitive problems with general anesthesia. — Jeff (clinical) [Ep 1 · 11:51](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=711)
- Most parents requesting epigastric hernia repair report the hernia is symptomatic with pain. (clinical) [Ep 1 · 12:25](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=745)
- There is a gap in knowledge about the optimal timing for repair of epigastric hernias and hydroceles. — Sharif (opinion) [Ep 1 · 13:02](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=782)
- Most surgeons repair hydroceles between 1 and 2 years of age, but the rationale for this timing versus waiting until 3-5 years is unclear. — Sharif (clinical) [Ep 1 · 13:20](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=800)
- 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 (opinion) [Ep 1 · 13:30](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=810)
- It is difficult to visualize true epigastric hernias (epiplocoeles with preperitoneal fat only) laparoscopically. — Todd Ponsky (opinion) [Ep 1 · 13:45](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=825)
- There is a risk of future adhesive bowel obstruction from the peritoneal defect created during laparoscopic epigastric hernia repair. — Jeff (opinion) [Ep 1 · 14:37](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=877)
- One finalist paper addressed whether there is always a tiny hole in hydrocele cases when performing single incision laparoscopic percutaneous closure of processus vaginalis without hydrocelectomy — Todd Ponsky (opinion) [Ep 3 · 1:17](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=77)
- 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 (opinion) [Ep 3 · 1:33](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=93)
- Abdominal scrotal hydroceles represent 0.17 to 3.1% of all hydroceles. (epidemiological) [Ep 2 · 0:08](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=8)
- Abdominal scrotal hydroceles should be considered in any patient with a large hydrocele. (clinical) [Ep 2 · 0:30](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=30)
- Diagnosis can be made by reduction of the scrotal hydrocele while palpating for an abdominal mass or by ultrasound. (clinical) [Ep 2 · 0:42](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=42)
- Pressure on the abdominal mass causes immediate re-expansion of the scrotal hydrocele, known as the spring back ball sign. (clinical) [Ep 2 · 1:35](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=95)
- Ultrasound confirms the diagnosis by demonstrating a dumbbell-shaped fluid-filled mass with scrotal, inguinal, and intraabdominal but extraperitoneal components. (clinical) [Ep 2 · 1:55](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=115)
- There are 3 main theories to explain the pathophysiology of abdominal scrotal hydroceles. (clinical) [Ep 2 · 2:15](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=135)
- At operation, the hydrocele sac is usually large, inflamed, and adherent to the cord. (clinical) [Ep 2 · 2:55](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=175)
- Dissection is often confusing because there are two separate sacs running along the cord at the level of the internal ring. (clinical) [Ep 2 · 3:05](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=185)
- Treatment of abdominal scrotal hydrocele is surgical, as spontaneous resolution is rare. (clinical) [Ep 2 · 3:15](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=195)
- The long-term effects of abdominal scrotal hydrocele on testicular development are unknown. (clinical) [Ep 2 · 3:25](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=205)
- For the past 10 years, the authors have used laparoscopy to confirm the presence of the abdominal scrotal hydrocele and monitor the repair, which is done through a standard groin incision. (clinical) [Ep 2 · 3:45](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=225)
- The Clatworthy technique is required to safely separate the sack from the vase and vessels when the sac is wide, thick, and adherent to cord structures. (clinical) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=240)
- The authors have used laparoscopy to guide the repair of 8 patients with abdominal scrotal hydroceles in the past 10 years. (clinical) [Ep 2 · 4:20](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=260)
- Although laparoscopy is not essential, the authors have found it to be a useful adjunct to ensure adequate repair and possibly decrease the risk of recurrent hernia. (opinion) [Ep 2 · 4:30](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=270)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The case involved a 5-year-old girl with epigastric swelling and tenderness that had not reduced for 6 months. — The host summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=0)
- The technique used a 3mm umbilical port and 3mm percutaneous instruments in the left anterior axillary line. — The host summarizing a resource [Ep 1 · 0:30](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=30)
- Finger pressure on the abdominal wall hernia bulge was used to identify the hernia site laparoscopically. — The host summarizing a resource [Ep 1 · 1:00](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=60)
- The peritoneum was opened, fatty tissue removed, and the hernia ring exposed and closed with interrupted percutaneous 3-0 PDS sutures. — The host summarizing a resource [Ep 1 · 1:30](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=90)
- The laparoscopic approach avoids a non-cosmetic incision and scar in the epigastric region. — The host summarizing a resource [Ep 1 · 2:20](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=140)
- Dr. Abello confirmed the hernia was a true epigastric hernia with fat, not omentum. — Todd Ponsky summarizing the discussion [Ep 1 · 4:34](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=274)
- Dr. Abello does not repair all asymptomatic epigastric hernias but does repair them in female patients due to pregnancy concerns. — The host summarizing the discussion [Ep 1 · 7:49](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=469)
- Adult surgeons report needing to take down the falciform ligament and open the peritoneum to visualize epigastric hernias laparoscopically. — Todd Ponsky summarizing the discussion [Ep 1 · 14:10](https://qa.library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=850)
- The winning paper was from Dr. Rebecca Figueira from the Hospital for Sick Children on fetal lung vascular development reduced by amniotic fluid stem cells extracellular vesicles in experimental congenital diaphragmatic hernia — Todd Ponsky summarizes what Dr. Rebecca Figueira said [Ep 3 · 4:11](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=251)
- This is the second year in a row that the same lab (Augusto Zani's lab) won the competition, with last year's presentation at CAS and this year's from EUPSA — Todd Ponsky summarizing the discussion [Ep 3 · 4:33](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=273)
- There are 1.5 million new publications per year in print journals — The host summarizing a resource [Ep 3 · 3:11](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-overall-winner-dr-rebeca-figueira-eupsa-6329?t=191)
- The most commonly accepted theory is that first described by Dupetrin in 1834 as a double sacked hydrocele, suggesting the abdominal scrotal hydrocele forms from a regular infantile hydrocele that enlarges over time pushing through the internal ring into the extraperitoneal space. — The host summarizing the discussion [Ep 2 · 2:25](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=145)
- Many different repairs are described in the literature, including inguinal, intraperitoneal, laparoscopic, and scrotal approaches. — The host summarizing the discussion [Ep 2 · 3:35](https://qa.library.globalcastmd.com/watch/laparoscopic-assisted-treatment-of-abdominoscrotal-hydrocele-2250?t=215)

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