Kathryn Martin1, Sherif Emil, Jean-Martin Laberge. 1. Division of Pediatric General Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Abstract
INTRODUCTION: Abdominoscrotal hydroceles (ASH) represent a difficult surgical problem in which a large scrotal hydrocele extends through the inguinal canal into the intraabdominal, extraperitoneal space, creating a widened internal ring that may be associated with an inguinal hernia. SUBJECTS AND METHODS: Patients with ASH were repaired using a combined laparoscopic-inguinal approach. Laparoscopic exploration was used to confirm the diagnosis, rule out associated hernia, assess for contralateral pathology, and confirm adequate peritoneal closure at the level of the internal ring, after a standard inguinal approach was used to repair the ASH. RESULTS: Eight patients are described with a median age of 13 months. One patient presented with bilateral ASH, and 5 patients had contralateral pathology, including simple hydrocele (n=3), undescended testicle (n=1), and inguinal hernia (n=2). Three patients were confirmed to have an ipsilateral inguinal hernia associated with their ASH. Postoperative complications included hematoma (n=2) and recurrent hydrocele (n=1). No patient developed ipsilateral or contralateral hernias following ASH repair (median follow-up, 3.2 years). CONCLUSIONS: Although laparoscopy is not essential, we have found it to be a useful adjunct to ensure accurate diagnosis and repair of abdominoscrotal hydroceles in children.
INTRODUCTION: Abdominoscrotal hydroceles (ASH) represent a difficult surgical problem in which a large scrotal hydrocele extends through the inguinal canal into the intraabdominal, extraperitoneal space, creating a widened internal ring that may be associated with an inguinal hernia. SUBJECTS AND METHODS: Patients with ASH were repaired using a combined laparoscopic-inguinal approach. Laparoscopic exploration was used to confirm the diagnosis, rule out associated hernia, assess for contralateral pathology, and confirm adequate peritoneal closure at the level of the internal ring, after a standard inguinal approach was used to repair the ASH. RESULTS: Eight patients are described with a median age of 13 months. One patient presented with bilateral ASH, and 5 patients had contralateral pathology, including simple hydrocele (n=3), undescended testicle (n=1), and inguinal hernia (n=2). Three patients were confirmed to have an ipsilateral inguinal hernia associated with their ASH. Postoperative complications included hematoma (n=2) and recurrent hydrocele (n=1). No patient developed ipsilateral or contralateral hernias following ASH repair (median follow-up, 3.2 years). CONCLUSIONS: Although laparoscopy is not essential, we have found it to be a useful adjunct to ensure accurate diagnosis and repair of abdominoscrotal hydroceles in children.