Does Surgical Technique Play a Role in Postoperative Hydrocele Formation in Pediatric Inguinal Hernia Repair?

Background: The effect of surgical technique on postoperative hydrocele formation after inguinal hernia repair (IHR) in pediatric patients is unclear. This study aims to compare postoperative hydrocele rates between laparoscopic and open pediatric IHRs and to evaluate the impact of distal sac resection on hydrocele formation. Study Design: A multi-center retrospective cohort study was conducted of male patients ≤ 18 years old who underwent IHR from January 2017 to December 2019 at 20 children’s hospitals. Males with cryptorchidism, sliding hernia or mesh repair were excluded. The primary outcome was postoperative hydrocele that required intervention (aspiration, drainage, hydrocelectomy). Comparisons of patient demographics, surgical techniques, and postoperative hydrocele rates between laparoscopic versus open repairs were performed; significance was defined as p<0.05. Results: A total of 8,305 pediatric hernia repairs were included: 5,749 (69.2%) open and 2,556 (30.8%) laparoscopic. Postoperative hydrocele developed in 21 (0.3%) patients with hydrocele intervention occurring at a mean of 4.0 months IQR 2.0, 7.5 following repair. Postoperative hydrocele rates did not differ between the open and laparoscopic cohorts (0.2% vs. 0.3%, p=0.467). Among the hernia repairs complicated by postoperative hydrocele, 10 (47.6%) had the distal hernia sac excised during repair and 11 (52.4%) did not have the distal hernia sac excised (p=0.563). Conclusions: Postoperative hydrocele after pediatric IHR is less than 0.5% for laparoscopic and open repair. Leaving the hernia sac in place was not associated with an increase in postoperative hydrocele and is unnecessary.