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In this issue of the Consult, Dr. Steve Dassel discusses the diagnosis and treatment of hernias with Dr. John Meehan, Jr., co-director of robotic surgery at Children's.
Q: Let's begin with a bit about the embryology of inguinal hernias, John.
A: In inguinal hernias, the testis migrates from the area of the kidneys and arrives in the scrotum by way of the inguinal canal at about 6-7 months. As it descends, it pulls a sac of peritoneum (processus vaginalis) with it. That canal should then close, but if it doesn't, it leaves an open avenue (a hernia) which may allow a loop of bowel to slide in.
Q: Just to tidy things up, how is that associated with a hydrocele?
A: Sometimes the sac of peritoneum closes, but peritoneal fluid was able to accumulate before that closure happened, forming the hydrocele. Alternatively, there may be a tiny opening that almost acts like a one-way valve and allows fluid to trickle down around the testes.