V7-12: A NOVEL LAPAROSCOPIC SURGICAL METHOD FOR COEXISTENCE OF TESTICULAR VARICOCELE AND IPSILATERAL HYDROCELE
VideoIntroductions and Objectives
Hydrocele is a common clinical problem in children worldwide, and the main cause is a congenital patent processus vaginalis (PPV)._x000D_ We experienced a pediatric case with left-sided communicating hydrocele and ipsilateral varicocele undergoing simultaneous minimally-invasive laparoscopic repair.
Case:An 11-year-old boy, with left sided scrotal mass, had been diagnosed as testicular varicocele in a clinic. He was sent to our hospital for minimally-invasive treatment._x000D_ At the initial visit, not only left-sided testicular varicocele, but also left-sided hydrocele were confirmed. Simultaneous laparoscopic repair of both diseases were planned._x000D_ Operative procedures: The patient was in a Trendelenburg position (15-degree head-down tilt) under general anesthesia. _x000D_ Laparoscopic repair of the left-sided varicocele using 3 5mm trocars followed by laparoscopic extraperitoneal repair of PPV using 2 small left inguinal incisions were scheduled._x000D_ Initially, laparoscopic high ligation of testicular veins were performed. For closing PPV, pre-peritoneal space was dissected, and a 5mm left inguinal skin incision was made. Through this incision, a 16 gauge vascular access needle was inserted into the pre-peritoneal space, and a 2-0 silk suture was inserted through the sheath of this 16 gauge needle. The 2-0 silk was trapped by 4-0 nylon suture loop via another 16 gauge needle, and was retracted through the same incision. The 2-0 silk suture was tied in the inguinal incision wound, resulting in partial closure of PPV. The same procedures were performed 6 times from lateral to medial direction. Finally, PPV was almost closed, and additional metal clips for final closure of the median peritoneum were used.
Eight months after operation, neither left-sided hydrocele nor varicocele was found. Successful simultaneous minimally-invasive laparoscopic repair was performed in a pediatric case with left-sided communicating hydrocele and ipsilateral varicocele.
This procedure is easy for experienced laparoscopic surgeon, and is a safe procedure.?@