Abstract
Purpose: Excision of hydrocele is reported to be essential for abdominoscrotal hydrocele (ASH). We have previously reported that the simple closure of processus vaginalis (PV) technique yields excellent outcome for childhood hydrocele. We conceived that simple closure of PV without excision of hydrocele might offer a cure for ASH. This is a report of our new approach for ASH treatment. The pathophysiology of ASH was considered based on our results.
Methods: Operations were done in 12 male childhood ASH cases. Hydrocele fluid was removed by a skin. A small inguinal groove incision was made and the spermatic cord was removed.
PV and hydrocele that extended into the abdomen were identified and dissected at the level of internal inguinal ring. PV, the common wall between PV and hydrocele, and the internal fascia were closed en bloc in 4 cases. PV, the whole of hydrocele, and internal fascia were closed in 8.
Results: All cases showed complete recovery without complications. In all cases, PVs were identified at the internal inguinal ring, where adhesions in and around the spermatic cord were severe. PVs and hydroceles were tightly adhered, forming inseparable common septa.
Conclusions: The results indicate that even if we had left hycroceles in place, blocking the supply route of ascites led to a complete cure in childhood ASH cases. This implies that ASH is a communicating hydrocele connected to the abdominal cavity through PV and possible microscopic pathways in the common septa. Operation shown here is a minimum invasive procedure, and is recommended as the first choice for childhood ASH treatment.
