From the Guidelines
Indication for Repair of Inguinal Hernia
In cases of moderate right-sided communicating hydrocele with patent processus vaginalis, repair of inguinal hernia is indicated to prevent potential complications such as hernia incarceration or strangulation 1.
Rationale for Indication
The presence of a patent processus vaginalis (PPV) is a significant risk factor for the development of inguinal hernias, with an estimated childhood risk of 25% to 50% if a PPV is present 1. Given that the prevalence of PPV is highest during infancy and declines with age, early intervention is crucial to avoid complications.
Surgical Approach
The recommended surgical approach is herniotomy with high ligation of the hernial sac, which may be performed under general anesthesia with a perioperative dose of cefazolin 1g IV. This approach is aimed at preventing further complications and promoting optimal outcomes.
Postoperative Management
Postoperative management typically includes:
- Analgesia with acetaminophen 650mg PO every 4 hours as needed
- A follow-up appointment within 1-2 weeks to assess for complications or recurrence
Key Considerations
It is essential to consider the individual circumstances of each patient, including age, gestational age, and the presence of any underlying medical conditions, when determining the optimal timing and approach for inguinal hernia repair 1. However, the overall consensus is that repair of inguinal hernia is indicated in cases of moderate right-sided communicating hydrocele with patent processus vaginalis to prevent potential complications.
From the Research
Indications for Repair of Inguinal Hernia
The presence of a moderate right-sided communicating hydrocele with patent processus vaginalis may be an indication for repair of inguinal hernia.
- A study published in 2017 2 found that endoscopic totally extraperitoneal (TEP) repair is a safe and effective method for repairing adult inguinoscrotal hernias associated with completely patent processus vaginalis.
- Another study published in 2018 3 found that primary hydrocele with macroscopic features indicative of tunica vaginalis inflammation requires reversion of the tunica as part of the operative strategy to minimize recurrence.
- A study published in 2014 4 found that primary new-onset hydroceles presenting in late childhood and pre-adolescence resemble the adult type hydrocele pathology and may not have a patent processus vaginalis.
- A study published in 2010 5 found that hydrocele of the spermatic cord in infants and children has particular characteristics, including the presence of a patent processus vaginalis in some cases, which may require herniotomy to prevent later occurrence of an inguinal hernia.
Key Considerations
- The presence of a patent processus vaginalis is a key factor in determining the need for repair of inguinal hernia 2, 5.
- The type of hydrocele, such as communicating or non-communicating, may also influence the decision to repair the inguinal hernia 3, 4.
- The age of the patient and the presence of other symptoms or conditions may also be considered when deciding whether to repair the inguinal hernia 4, 5.