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BOB Ped Surg 2023 - Tran Ngoc Son, WOFAPs - Presentation
With Dr. Tran Ngoc Son
Chapter 1 of 5 · Fundamentals
Study rationale
Introduction and study rationale
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What the experts said
Traditional hydrocele repair is open repair with an incision, high ligation of PPV, and hydrocelectomy (total, partial, or aspiration).
Laparoscopic surgery is increasingly used in treatment of pediatric inguinal hernia but not yet popular in treatment of hydrocele.
The SIPC technique uses two ports placed through a single umbilical incision, with extraperitoneal closure of PPV at the internal inguinal ring using 2-0 suture with a percutaneous needle and white lasso.
No hydrocelectomy or penetration of the hydrocele was performed in this technique.
Hydrocele fluid was pushed back to the peritoneal cavity via the internal ring by external manual pressing, and if unsuccessful, the fluid was evacuated by percutaneous needle puncture.
553 patients were enrolled with median age of 34 months, ranging from 2 to 14 years.
Ipsilateral patent PPV was found in 100% of patients.
In nearly 30% of cases there was no obvious communication between the hydrocele and the peritoneal cavity.
Median operative time was 70 minutes.
Median postoperative stay was 1 day.
There were no major complications.
At a median follow-up of 41 months, the recurrence rate was 0.36%.
Postoperative cosmesis was excellent.
In cases where the hydrocele had no obvious connection with the peritoneal cavity, the PPV was still ligated and the fluid evacuated with percutaneous needle, with no recurrence recorded.
In cases with no obvious peritoneal communication, there is likely still a discrete one-way passage of peritoneal fluid towards the scrotum, but not in the opposite direction.
The fluid in primary hydrocele is actually peritoneal fluid, not fluid produced by the hydrocele cyst 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.
Meta-analyses show that laparoscopic surgery has advantages of less trauma, reduced postoperative pain, faster recovery, improved cosmesis, and fewer complications than conventional open surgery, with the added advantage of ability to explore the contralateral internal inguinal ring.
Simple puncture and fluid aspiration alone is ineffective in the management of hydrocele.
The principle of laparoscopic management of pediatric hydrocele is controversial, with some authors using closure of PPV at the internal ring with hydrocelectomy or wide fenestration, while others perform high PPV ligation without hydrocelectomy.