What is a fluid hernia or congenital hydrocele

A congenital hydrocele is one that a baby is born with.
During development in the womb, all babies normally form a short tunnel through the abdominal wall. In boys, this connects the abdominal cavity with the scrotum. This tunnel has a thin lining called the "processus vaginalis." This lining is the extension of the same layer that lines the inside of the abdominal cavity.
The tunnel between the abdominal cavity (the belly) and the scrotum serves a purpose in boys. During development in the womb, the testicles initially grow inside the boy's tummy and descend through this tunnel to end up in his scrotum. This tunnel and its lining are supposed to seal off prior to the baby being born.
Sometimes when it seals off, some fluid is trapped around the testicles in the scrotum. This trapped fluid is called a non-communicating hydrocele. Sometimes the tunnel closes down but does not close completely. As a result, at times the fluid can drip down and accumulate in the scrotum to cause it to look bigger while at other times it can drain back into the abdominal cavity and thus make the scrotum look normal in size. This is called a communicating hydrocele because there is still a tunnel "communicating" between the belly and the scrotum.

What is the treatment for a non-communicating hydrocele?

For most patients less than a year of age, surgeons will often recommend observing (just watching) non-communicating hydroceles. This is because many of these hydroceles will go away on their own. However, if the hydrocele fails to disappear by the time the child reaches his or her first birthday, then it is unlikely to do so. In this situation, the child will probably need an operation.

How is the procedure done?

The operation is done under general anaesthesia. The operation for a hydrocele involves making a very small cut in the lower abdomen in the groin area. The fluid is then drained from around the testicle (testis). The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot reform in the future. This is a minor operation and is performed as a day case, so does not usually involve an overnight stay in the hospital. The nerve supplying the wound area will be numbed with an anaesthetic while your child is sleeping to help with post-operative pain control. Antibiotics are administered before the procedure in theatre to help with the prevention of infection.

Diagram

Risks of the procedure

• As with any operation under general anaesthesia, there is a very small risk of complications related to the heart and the lungs.
• Complications are rare and seldom serious. 
• Bleeding is very rarely a problem and can usually be settled with some extra pressure on the wound area. Extremely rarely, another operation may be needed to stop the bleeding.
• Infection is a rare problem and settles down with antibiotics in a week or two.
• Recurrence of the hydrocele is very rare.
• Extremely rare complication: damage to the blood supply to the testis resulting in necrosis (death) of the testicle.

Before the procedure

• Please make sure that your child does not eat for at least 8 hours prior to the operation and does not take any fluid in for 6 hours prior to the operation.
• Please inform us if your child does not feel well and has any upper respiratory symptoms.

After the procedure

• Watch your child closely on the day of the surgery. 
• Some redness and swelling around the wound area is normal and will disappear in the first 2-4 days
• The dressing must be kept dry for 5-7 days. Do not open the dressing during this time.
• Pain medication will be prescribed.
• The sutures will dissolve in 14-21 days time. Do not remove any visible sutures.
• Sponge bath at home only. Avoid a tub bath until seven days after surgery.
• Avoid swimming until 2 weeks after the surgery.

If your child is younger than 2 years of age:

• Younger children will limit their own activities, like crawling and walking.
•  Avoid any straddle activities with your child that would increase pressure between their legs for 1 week.
  This includes:
  • Holding the child on your hip
  • Bouncing the child on your knee
  • Baby-wearing devices
  • Bouncer toys that require a harness
  • Car seats and stroller straps are safe

If your child is 2 years of age or older:

• Avoid strenuous activities, rough play or activities that involve straddle activity.
• A good guideline for your child is to keep “both feet on the ground” for 1 week.
• Types of activity to avoid for 1 week: Jungle-gyms, climbing, bikes and trikes.
• After-school sports.

Please phone the rooms for a follow-up appointment in 2-4 weeks time.

Phone us if any of the following occurs

• Your child is in a lot of pain and pain relief does not seem to help.
• Your child has a high temperature and paracetamol does not bring it down.
• The wound site looks red, inflamed and feels hotter than the surrounding skin.
• There is any oozing from the wound.
• Bleeding from the wound that soak the dressing.

Information and consent form

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