Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children Bilal Firat Alp, Hasan Cem Irkilata, Yusuf.

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Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children Bilal Firat Alp, Hasan Cem Irkilata, Yusuf Kibar, Unal Zorba, Ahmet Ali Sancaktutar, Engin Kaya, Murat Dayanc The Kaohsiung Journal of Medical Sciences Volume 30, Issue 4, Pages 200-205 (April 2014) DOI: 10.1016/j.kjms.2013.11.006 Copyright © 2013 Terms and Conditions

Figure 1 Surgical steps of the scrotal approach for the treatment of communicating hydrocele. (A) Scrotal components brought outside the scrotal incision. (B) Appearance of hydrocele sac, spermatic vessels, and vas deference. (C) External spermatic fascia opened from the counterside of the hernia sac (from the side that was near the vessels and vas, but did not have any margin with hydrocele sac). (D) The hernia sac was separated bluntly from the other components of spermatic cord. (E) After Trendelenburg position, the sac was dissected up to the external inguinal ring and “a caudal traction” on the sac resulted in an extra separation from the cord structures. (F) External inguinal ring was seen (black long arrow). Flexibility of scrotal skin and appropriate retractors provided an excellent exposure of inguinal region (black short arrow). Hernia sac and other spermatic cord structures were seen (white arrows). (G) Patent processus vaginalis was tied as cranially as possible using a 3–0 or 4–0 absorbable suture. (H) The scrotal skin was closed with running subcuticular absorbable suture. The Kaohsiung Journal of Medical Sciences 2014 30, 200-205DOI: (10.1016/j.kjms.2013.11.006) Copyright © 2013 Terms and Conditions

Figure 2 Illustrations for scrotal hydrocelectomy. (A-1 and A-2) Vertical and horizontal normal appearance of the hydrocele sac. (B-1 and B-2) Vertical and horizontal appearance of separation of hernia sac from other components of the spermatic cord. (C) Hernia sac was dissected up to the external inguinal ring and “a caudal traction” on the sac provided an extra separation from the cord structures. (D) Traction of the sac was simultaneously ended and the proximal part of processus vaginalis fell back into the peritoneal cavity. The divided hydrocele sac was seen. The Kaohsiung Journal of Medical Sciences 2014 30, 200-205DOI: (10.1016/j.kjms.2013.11.006) Copyright © 2013 Terms and Conditions

Figure 3 Pre- and postoperative appearances. (A) Preoperative appearance of the right hydrocele. (B and C) Unilateral left and right side scrotal incision scars, 6 months after hydrocelectomy. (D) Bilateral scrotal incision scars, 6 months after hydrocelectomy. The Kaohsiung Journal of Medical Sciences 2014 30, 200-205DOI: (10.1016/j.kjms.2013.11.006) Copyright © 2013 Terms and Conditions