What is it?
There is a gathering of fluid around the testicle. This is called a hydrocele. The fluid comes from the lining of the tummy and trickles down a narrow tube to lie around the testicle. This tube can be either:
- completely closed (non-communicating hydrocele)
- or very narrow and not allow any organs from the tummy (the bowel most commonly) to come through it
- or sometimes the tube is quite wide in part, so that the bowel or other organs can bulge through, making a hernia.
It is something your child was born with, but it is not the parents' fault.
Your child will have a general anaesthetic, and will be completely asleep. A small cut is made in the groin. The narrow tube is then identified, any organs – such as the bowel - that are in the tube and causing a hernia are pushed back in the tummy and the fluid around the testicle is emptied out. Some of the fluid is sent to the laboratory for examination. The part of the tube towards the testicle is removed and the part of it towards the tummy is tied (ligated) twice. Sometimes, when the hernia is big, stitches are needed to close the gap in front of the tummy that allows the narrow tube to come through the tummy wall towards the testicle and make the hernia. The cut is closed up. Sometimes a second cut is made in the scrotum to fix the testicle in its proper place. The operation takes about 20 minutes a side.
TIf your child has a non-communicating hydrocele, there is a very good chance that it will go away by the time he is 12 months old. If this doesn’t happen by the age of 12 months then an operation is necessary. An operation is also necessary if the hydrocele communicates with the tummy or if a hernia is present. Injections will not work. If you leave things as they are, the build up of fluid may become large and uncomfortable. Hormone treatment does not work. Trusses and supports are of no value.
Before the operation
Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that the anaesthetic can be administered safely. If your child has a cold in the week before admission to hospital, please telephone the ward and let ward sister know. The operation will usually need to be put off. Your child has to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.
Sort out any tablets, medicines, and inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, your child may be checked for past illnesses and may have special tests to make sure that he is well prepared and can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for your child to have these checks.
After - in hospital
Your child may not notice any particular pains. If necessary he can take paracetamol liquid. By the end of one week, the wound should be virtually pain-free. Your child will be able to drink again about two to three hours after the operation. Your child should be able to eat normally the next day. Usually you can take your child home on the day of the operation. You may be given an appointment to bring your child to the outpatient department a month or so after leaving hospital for a check-up. The results of the examination of the fluid from around the testicle should be ready by then. Sometimes the family doctor checks the wound instead.
After - at home
Your child may need frequent sleeps for a day or two. Although it is usually difficult to limit what he does, try to help your child avoid any excess physical activity for four to six weeks after the operation especially if he is over five years old. The groin wound is usually held together underneath the skin with stitches that eventually dissolve and which don’t need to be removed. . There may be stitches in the wound, which should melt away in about 7 to 10 days. It is rare for the stitches to need taking out. There may be some bruising of the surrounding skin which will improve in two to three days. This is expected and you or your child should not worry about it. Your child can wash but should try to keep the wound area dry until the stitches melt away or for about a week if there are only stitches under the skin. Salt water is not necessary. If your child goes to school, he can return to lessons in 10 days or so. Your child can restart any sport after about four to six weeks.
As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. There is often some swelling and even some redness around the wound. These settle in three or four days. Bleeding is very rarely a problem and can usually be settled with some extra pressure on the wound area. Extremely rarely, another operation may be needed to stop the bleeding. Infection is a rare problem and settles down with antibiotics in a week or two. Sometimes the stitches take a month or more to drop out of the wound. This can happen and you or your child should not worry about it. Recurrence of the hydrocele is very rare. Sometimes the testicle lies a little higher than before. Consult the surgeon if either of these happen.
Two other extremely rare complications that can happen during this operation is damage to the structures that carry the sperm from the testicle or damage to the pipes (vessels) that feed the testicle with blood. This can have an affect either on you child’s fertility in the future (his ability to father children) since one of his testicles will not contribute sperm or can cause a significant damage or even necrosis (death) of the testicle. You should discuss the possibility of those extremely rare complications with your surgeon.
These notes will help you and your child through the operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.