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Communicating hydrocele/hernia
repair in children
Barry A. Kogan
Urological Institute of Northeastern New York, Albany, New York, USA
ILLUSTRATIONS by STEPHAN SPITZER, www.spitzer-illustration.com
INTRODUCTION
Hydrocele surgery in children can be simple or
remarkably complex, depending on the child’s
anatomy and the surgeon’s experience.
Importantly, a hydrocele in a child is most
frequently a communicating hydrocele, with a
patent processus vaginalis. In these cases the
critical step in the operation is a high ligation
of the hernia sac (the patent processus
vaginalis). Dealing with the hydrocele itself is
secondary and often unnecessary.
Surg Ill Article
surgery illustrated
KOGAN
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K O G A N
Figure 1
Locate the external inguinal ring about 3 cm
superior and lateral to the pubic tubercle, and
mark a 2–3 cm incision line along Langer’s
lines in a skin crease on
both
sides (just in
case there is a contralateral hernia that needs
repair). Using a knife and fine-tipped cautery,
open the skin and subcutaneous tissue down
to the external oblique, and by spreading,
clear the inguinal ligament down towards the
symphysis until the external ring is clearly
delineated (slight tension on the testis will
help to delineate the cord exiting the external
ring).
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S U R G E R Y I L L U S T R A T E D
Figure 2
Often it is possible to identify the ileo-
inguinal nerve just beneath the fascia. Incise
the external oblique sharply along the course
of its fibres so that the incision opens through
the external ring. Care mus