Orchidopexy during inguinoscrotal hydrocele repair: is it necessary?

BACKGROUND: The advantage of concomitant orchidopexy during the repair of the inguinoscrotal hydrocele is controversial. Our objective was to compare the traditional inguinal repair with or without transscrotal orchidopexy for the management of inguinoscrotal hydroceles in children. METHODS: From 2012 to 2020, 341 patients had a surgical repair for scrotal hydrocele; 287 patients with simple hydrocele were excluded. Fifty-four patients who underwent large hydrocele repair were included and divided into two groups. Patients who had traditional inguinal repair were included in group A (N.=29), and group B included patients who had the inguinal approach with trans-scrotal orchidopexy (N.=25). RESULTS: The mean age in group A was 11.21 +/- 1.44 versus 11.08 +/- 1.28 months in group B, and there was no difference in age either at presentation or at the surgery between groups (P=0.39 and 0.73, respectively). Patients in group B had longer operative time (52 +/- 10.75 vs. 61 +/- 11.92 minutes in groups A and B, respectively; P<0.001). No patient had postoperative bleeding in both groups. Group A had significantly more hematoma (48% vs. 8%; P=0.002) and scrotal swelling at 6 weeks (31% vs. 4%; P=0.014). Return to normal size was significantly faster in group B (4.8 +/- 1.7 vs. 1.5 +/- 0.8 months in groups A and B, respectively; P<0.001). CONCLUSIONS: Inguinal hydrocelectomy with orchidopexy is safe and feasible for the management of large inguinoscrotal hydrocele. This technique has a low complication rate.