Treatment of choice for congenital hydrocele?
Ans. B. Herniotomy. (Ref. Bailey and Love 26th/pg. 1382; 381).# In congenital hydrocele, the processus vaginalis is patent and connects with the peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Pressure on the hydrocele does not always empty it but the hydrocele fluid may drain into the peritoneal cavity when the child is lying down; thus, the hydrocele is often intermittent. Ascites should be considered if the swellings are bilateral.# Congenital hydroceles are treated by herniotomy if they do not resolve spontaneously.# Established acquired hydroceles often have thick walls. Lord's operation is suitable when the sac is reasonably thin- walled. There is minimal dissection and the risk of haematoma is reduced. Eversion of the sac with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum is an alternative (Jaboulay's procedure).# Herniotomy: In children who have lateral hernias with a persistent processus, it is sufficient only to remove and close the sac. This is called a herniotomy. In adult surgery, herniotomy alone has a high recurrence rate and some form of muscle strengthening is added (herniorrhaphy).
Sac eversion
Herniotomy
Conservative
Hernioraphy
Testis & Scrotum