title: Surgery for hydrocele in children-an avoidable excess?
abstract: BACKGROUND
  There is little consensus over the optimal timing of ligation of a patent processus vaginalis (PPV) in boys with hydrocele. We hypothesized that a proportion of procedures may be unnecessary because they are performed at an age before which the PPV may be expected to close spontaneously. Such excess may expose the child to unnecessary surgery and have significant cost implications.
  
  
  METHODS
  A systematic literature review relating to timing of PPV ligation and a population-based study to define number of PPV ligations performed annually in England and age at surgery were conducted.
  
  
  RESULTS
  Most hydroceles resolve before 2 years of age, but their natural history beyond this age is poorly documented. Current guidelines recommend PPV ligation at 2 years of age. An average of 2878 operations for hydrocele is performed per year in children in England. Commonest age at repair is 2 years. There are no randomized controlled trials comparing PPV ligation with an observational nonoperative approach.
  
  
  CONCLUSIONS
  The natural history of hydrocele is poorly documented beyond the age of 2 years. There is no good evidence to support current practice. Delaying surgery may reduce the number of procedures necessary without increasing morbidity. A prospective study to investigate this is warranted.
authors.affiliation: UCL Institute of Child Health, London WC1N 1EH, UK. n.hall@ich.ucl.ac.uk
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.forename: Ori
authors.initials: O
authors.lastname: Ron
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D017046:Cost Savings; D004739:England / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008026:Ligation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D009313:National Health Programs / Q000191:economics; D017410:Practice Guidelines as Topic; D012075:Remission, Spontaneous; D006848:Testicular Hydrocele / Q000453:epidemiology / Q000601:surgery*; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data