Hydroceles call for surgery if they cause symptoms, become large, or show a change in size during the day. If the hydrocele is "non-communicating," meaning that there is no related inguinal hernia, a cut is made in the scrotum. The hydrocele is cut out and tissue is removed.
If there is "communication," or a related inguinal hernia, a cut is made in the upper groin area. This allows the hernia to be repaired at the same time as the hydrocele. In children it is often better to use an approach through the groin to avoid missing a hernia.
A hydrocele can also form on the other side, and the risk is about 5 out of 100 cases. The urologist may want to check the other side of the groin, making a small cut through the abdominal wall and looking through a small laparoscope (instrument inserted through the abdominal wall).
How are Hernias Treated?
Surgery to fix the muscle ring that did not close is recommended for a hernia in a child. Hernias do not go away on their own. They may cause problems if they block the bowels, and this can lead to the need for emergency surgery. In infants and children, a small cut is made in the groin. The urologist sews the canal shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teens and adults, laparoscopic surgery (performed through the abdominal wall) may be considered.
A hernia can develop on the other side of the groin, but this depends on the age of the child. Younger children treated for a hernia are much more likely to have a hernia on the other side. In younger children a laparoscope is sometimes used to look at the opposite side. If the exam shows that a hernia is present or likely to occur, then surgery on both sides is done as a preventive measure.