The Condition

An hydrocele is a lump in the scrotum, made of fluid that tracks down from the abdomen through an opening in the abdominal muscles. It is the same opening as an inguinal hernia, just narrower, so the intestine doesn’t bulge through. A hydrocele is often present at birth, and resolves in the first 2 years of life.

It is not dangerous, and repair can be considered after 1-2 years if it is still present. In children the repair is similar to an inguinal hernia repair.

Infantile hydroceles are different than adult ones.  

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  Inguinal hernia with bowel out

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  Hydrocele

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  Inguinal hernia with empty sac

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  Inguinal hernia female

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  Inguinal hernia - ovary out

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  Inguinal hernia with empty sac - female

There is a delay or failure of closure of the track through which the testis (in boys) migrates to the scrotum during development. This opening allows abdominal contents such as bowel to bulge through the opening.

They often get worse during a viral illness such as cold or flu. This is because there is more fluid in the abdomen, which travels down to the scrotum. This is not dangerous. 

Not urgently. Most repairs are done after 2-3 years age, to allow it to resolve on its own, or if it starts causing symptoms like pain or annoyance. 

No – hydroceles are not dangerous. They often resolve after 1-2 years age. Persistent or new hydroceles may require surgery.

Treatment

A day procedure under general anaesthetic, through a small incision in the groin. This is the same repair as an inguinal hernia repair in an infant. The connection is closed with sutures, and the wound is closed with dissolvable sutures. There is no mesh.

Adolescents may require an adult type approach, which is performed through the scrotum. 

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  Inguinal hernia repair - male

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  Inguinal hernia repair - female

The operation takes about 15-20 minutes. 

The anaesthetic can take about the same time before and after, so you’ll be away from your child for an hour or so, until they are ready for you in the recovery room. You will be notified when they are ready for you to see them in recovery.

There is usually no need to evaluate the other side if there is no swelling seen. Your surgeon will determine this when examining your child. 

The anaesthetic –  airway and breathing issues are extremely rare

• Recurrence – about 1% for most children, more often in premature infants.
• Injury to structures – the testicle, blood vessels and the vas deferens may be injured very rarely.
• Infection -1%
• Bleeding, bruising and swelling. Usually minor.

Recovery

Recovery – you will be called into the recovery room just after they are awake.

Feeding – you can give your child a feed in the recovery room. 

Home – usually after an hour or 2, once the nursing team have ensured your child is safe and comfortable

The area will become swollen, and a little firm under the wound. This is a normal healing process and developing scar. The scar becomes dark red for the first few months, then becomes more pale.

There is a waterproof dressing in the groin that can be removed in the bath / shower after a week.

Your child will receive good pain relief in the operating room, that will last a few hours. 

After the operation they will need paracetamol and possibly ibuprofen (eg. Nurofen) for a few days. Please let your surgeon and anaesthetist know if your child has intolerances or allergies. 

In order to avoid medication, aim to distract your child and keep their mind off the area. Reading, writing, playing board games and other engaging activities help. 

Bath / shower – the day after the operation

Swimming – 1 week

Daycare / School – 5-7 days

Sports – 2-3 weeks

Troubleshooting

This may be an inguinal hernia – you need to seek medical attention with your GP or surgeon to be assessed and managed. If it is tender, firm and your child is vomiting, go to the emergency department, as it may be an irreducible inguinal hernia. 

Infections can develop around 2-4 days after the operation, and is a fairly uncommon issue. 

The wound may be infected if there is increasing redness around the wound and tenderness. This may be associated with discharge from the wound site. 

You will need to see your family doctor or call your surgeon for further advice. 

It does become swollen after the operation, usually for a few days. 

If your child has increasing pain, tenderness and vomiting associated with a similar bulge to before the operation there may be recurrence. If your child is unwell, you may need to go to the emergency department. Call your surgeon and let them know. 

Otherwise see your GP and call your surgeon so your child can be assessed. 

You know your child best. If you have any concerns please see your family doctor or call your surgeon. The list below are issues that require medical attention. 

• Increasing pain or persisting pain despite pain relief
• Increasing swelling or bulge – possible recurrence
• Fever >38.2 degrees Celsius
• Vomiting and feed intolerance
• Discharge or bleeding from the wound
• No bowel motions after 3 days