From the Guidelines
Surgical repair is the recommended treatment for a right inguinal hernia with a partially included right hydrocele, as it addresses both conditions simultaneously and prevents potential complications like incarceration or strangulation. The approach typically involves an inguinal herniorrhaphy, where the surgeon pushes the protruding tissue back into place and strengthens the weakened area with sutures or mesh, as supported by the guidelines for emergency repair of complicated abdominal wall hernias 1.
For the hernia repair, the use of mesh in clean surgical fields is associated with a lower recurrence rate without an increase in wound infection rate, as stated in the guidelines 1. The guidelines recommend the use of synthetic mesh for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) 1.
During the same procedure, the hydrocele will be drained and the tunica vaginalis may be partially removed or reattached to prevent recurrence. This combined procedure is typically performed under general anesthesia or local anesthesia (LA), which can provide effective anesthesia with less postoperative complications for emergency inguinal hernia repair in the absence of bowel gangrene 1.
Post-operative care includes:
- Pain management with acetaminophen or NSAIDs as needed
- Limited physical activity for 4-6 weeks
- Avoiding heavy lifting (over 10 pounds) during recovery
- Wearing a scrotal support or tight underwear to reduce swelling and discomfort.
It is essential to note that surgery is necessary because inguinal hernias don't resolve on their own and can lead to complications, while hydroceles can cause discomfort and occasionally become infected if left untreated. The choice of surgical approach, whether open or laparoscopic, depends on the specific case and the surgeon's preference.
From the Research
Diagnosis and Treatment of Right Indiana Hernia and Hydrocele
- The diagnosis of inguinal hernias, such as a right Indiana hernia, can be made through physical examination, and ultrasonography may be used to confirm the diagnosis or to diagnose a recurrent hernia or suspected hydrocele 2, 3.
- The treatment of inguinal hernias and hydroceles can be surgical, with options including open or laparoscopic repair 2, 3.
- Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair 2.
- However, concurrent hydrocelectomy during inguinal herniorrhaphy may be a risk factor for complications and reoperation, as seen in a study from rural Haiti 4.
Management of Hydrocele
- Hydroceles can be managed surgically, and the current concepts in the management of inguinal hernia and hydrocele in pediatric patients have been reviewed in the literature 5, 6.
- The role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele has been discussed, emphasizing the current use of minimally invasive surgery (MIS) in pediatric patients 5, 6.
- The management of particular aspects of these pathologies, such as bilateral hernias, contralateral patency of the peritoneal processus vaginalis, and incarcerated or recurrent hernias, has also been discussed 5, 6.
Considerations for Treatment
- The decision to treat a right Indiana hernia and hydrocele should be made on a case-by-case basis, taking into account the patient's symptoms, medical history, and other factors 2, 3.
- Watchful waiting may be a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias, but it is not recommended in patients with symptomatic hernias or in nonpregnant women 2.