Laparoscopic-assisted Treatment of Abdominoscrotal Hydrocele

Abdominal scrotal hydroceles represent 0.17 to 3.1% of all hydroceles.

Abdominoscrotal hydroceles should be considered in any patient with a large hydrocele.

Diagnosis can be made by reduction of the scrotal hydrocele while palpating for an abdominal mass or by ultrasound.

Pressure on the abdominal mass causes immediate re-expansion of the scrotal hydrocele, known as the spring back ball sign.

Ultrasound confirms the diagnosis by demonstrating a dumbbell-shaped fluid-filled mass with scrotal, inguinal, and intraabdominal but extraperitoneal components.

There are 3 main theories to explain the pathophysiology of abdominal scrotal hydroceles.

The most commonly accepted theory is that first described by Dupetrin in 1834 as a double sacked hydrocele, suggesting the abdominal scrotal hydrocele forms from a regular infantile hydrocele that enlarges over time pushing through the internal ring into the extraperitoneal space.

At operation, the hydrocele sac is usually large, inflamed, and adherent to the cord.

Dissection is often confusing because there are two separate sacs running along the cord at the level of the internal ring.

Treatment of abdominal scrotal hydrocele is surgical, as spontaneous resolution is rare.

The long-term effects of abdominoscrotal hydrocele on testicular development are unknown.

Many different repairs are described in the literature, including inguinal, intraperitoneal, laparoscopic, and scrotal approaches.

For the past 10 years, the authors have used laparoscopy to confirm the presence of the abdominal scrotal hydrocele and monitor the repair, which is done through a standard groin incision.

The Clatworthy technique is required to safely separate the sack from the vase and vessels when the sac is wide, thick, and adherent to cord structures.

The laparoscope monitors the progress and confirms the absence of a breach in the peritoneum during dissection.

The authors have used laparoscopy to guide the repair of 8 patients with abdominal scrotal hydroceles in the past 10 years.

Although laparoscopy is not essential, the authors have found it to be a useful adjunct to ensure adequate repair and possibly decrease the risk of recurrent hernia.