Congenital Hydrocele and Hernia
Congenital hydrocele and hernia in children are due to the persistence of the communication between the abdominal cavity and the covering around the testicle (tunica vaginalis). When the testicle descends downwards it brings a sleeve of covering from the abdominal cavity (peritoneal covering) which as it comes to the groin and this communication remains open until shortly before birth. This communication, which is called patent processus vaginalis, closes just before birth and disconnects the covering around the testicle (tunica vaginalis) from the internal covering of the abdominal cavity. If this communication remains patent without full closure, that could lead on to either congenital hydrocele or hernia. If that communication is bigger it will allow passage of bowel or other contents from the abdomen to descend down to the scrotum which is called a congenital hernia. If the communication is very tiny and if it does not allow any solid contents from the abdominal cavity the fluid may escape into the scrotum and collect around the testicle which is called congenital hydrocele.
How does congenital hydrocele differ from adult hydrocele?
In adult males the hydrocele is due to imbalance between the fluid production within the testicle and fluid absorption. On the contrary in children, this congenital hydrocele is due to the communication between the abdominal cavity and the coverings around the testicle which results in the passage of fluid from the abdominal cavity and its collection around the testicle. Congenital hydrocele varies in size due to the passage of fluid back and forth into the abdominal cavity. Unlike the adult hydrocele which remains constant in size. Treatment is also different in congenital hydrocele to that of the adult hydrocele. In congenital hydrocele the treatment is the disconnection of the communication between the scrotum and abdominal cavity which is the same as the treatment for hernia. However in the adult hydrocele the operation is done through the scrotum to open the coverings of the testicle and put it in such a way that fluid will not collect again.
What is the surgical treatment for congenital hydrocele and hernia?
The congenital hydrocele and hernia are treated in the same way by operation through the groin and disconnecting the communication between the abdominal cavity and coverings around the testicle. If there is any hernia and this hernia can be reduced (which means that any protrusion from the abdomen can be put back into the abdomen and this communication will be disconnected.
What are the risk and complications of surgery for congenital hydrocele and hernia?
Any complications related to open complications which include wound infection and bleeding.
A small chance of damage to the vas deferens (about 5%) which could result in the blockage of the vas. If the other testicle is normal this may not have major influence on the later fertility of the child into his adulthood.
There is a small chance of injury to the blood vessel to the testis which may result in the inadequate blood supply to the testis that would eventually cause shrinkage of the testis (testicular atrophy).
When is the optimal time to treat the congenital hydrocele?
One can expect the congenital hydrocele to cure spontaneously up to 24 months of age. This can be only expected to happen in the absence of any obvious hernia. If the hydrocele is persistent after 24 months, then a referral would be required to deal with this problem.