Hydrocele, Nuck Hydrocele: Standard Procedure

Abstract

Congenital hydroceles are classified into communicating and noncommunicating according to the presence of a macroscopic communication between the hydroceles and free abdominal cavity. Simple high ligation of the hydrocele or patent processus vaginalis is effective treatment. Surgery is performed in patients whose hydroceles persist beyond 2 or 3 years of age and in patients with new hydrocele development after this period.

The principle of hydrocele surgery is to block the flow of ascites from the abdominal cavity to hydroceles. To achieve this, the hydrocele is ligated as high as possible at the level of the internal inguinal ring in communicating hydroceles, while the patent processus vaginalis is ligated as high as possible in noncommunicating hydroceles. The procedure of hydrocele surgery is basically the same as surgery for inguinal hernia repair. However, hydroceles or the patent processus vaginalis is thinner than the hernia sac, and it may be occasionally difficult to identify the patent processus vaginalis in hydrocele patients. Generally, hydrocele surgery is more difficult than hernia repair, and, therefore, meticulous and delicate skills are required. Late postoperative complications include wound infection and hydrocele recurrence.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd., 2013, with the exception of occasional newly added figures that may appear.