LAPAROSCOPIC EVALUATION OF CONTRALATERAL PATENT PROCESSUS VAGINALIS IN GIRLS WITH INGUINAL HERNIAS

INTRODUCTION AND OBJECTIVE: Abdominoscrotal hydroceles (ASH) can present a formidable surgical challenge even to an experienced surgeon. They are extremely difficult to correct due to the complex nature of the hydrocele looping back through the internal ring back into the abdomen. This makes identification of the hernia opening difficult at times. We have utilized the Jones preperitoneal approach to handle these hydroceles with improved success. METHODS: We operated on 11 hernias in 7 patients ranging in age from 6 months to 1.5 years. All patients were males, 6 were on the left side and 5 were right sided. Surgical exploration was performed via an inguinal incision and the external inguinal ring was exposed. An incision was made superior to the hydrocele at the level of the internal ring. The muscle layers were split and the hydrocele was identified as it entered the internal ring. The Vas and vessels are then isolated extraperiotneally and tagged. The hydrocele is then dissected from the retro peritoneum and drained. The sac can be followed into the internal ring. The hernia defect can be closed from the inside. The excess hydrocele sac is excised and the testis inspected. If there is a need the testis can be fixed in the scrotum in a subdartos pouch. RESULTS: All patients had and excellent result with a marked reduction in operative time and a decrease in the manipulation of the cord structures. There was no evidence of testicular atrophy noted in any of the patients. CONCLUSIONS: This appears to be an improved approach to the abdominoscrotal hydrocele minimizing the risk of injury to the vas and vessels during the dissection of the large, redundant sac which is commonly encountered in these cases. Intraoperative times is significantly reduced compared to standard inguinal techniques.