Canadian Journal of Surgery
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Background: Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of parasite eradication programs.
Methods: We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded.
Results: From January to March 2010, 4922 patients were seen, none of whom had elephantiasis. Of the 64 patients who collectively underwent 69 inguino-scrotal procedures, 5 patients had inguinal hernia repair several years after hydrocele excision via the scrotum, 19 patients with bilateral hydroceles underwent a scrotum-only approach, and 45 patients had an inguinal approach (33 unilateral and 12 bilateral) to repair 57 hydroceles. A patent processus vaginalis was present in 50 of 57 (88%) hydroceles where the groin was explored.
Conclusion: Hydroceles remain common in Léogâne despite successful eradication of filariasis with mass drug administration using diethylcarbamazine-fortified cooking salt. Persistent patent processus vaginalis is a more likely cause than persistent filariasis. There is probably little difference between hydrocele in developed countries and tropical hydrocele other than neglect. Hydrocele prevalence is not a measure of the effectiveness of parasite eradication programs.
The recent earthquake in Haiti has highlighted not only the response required for such disasters, but also the ongoing battle against endemic diseases, such as lymphatic filariasis. 1 Canadian Field Hospital was deployed to Léogâne, the epicentre of the earthquake, on Jan. 12, 2010. Wuchereria bancrofti, the most common causative organism of lymphatic filariasis, was endemic in the Léogâne area until eradication by mass drug administration using diethylcarbamazine (DEC) in cooking salt.1 Once the injured were cared for, the surgical needs of the community were addressed. Large numbers of male patients came to our hospital seeking help for disabling hydroceles. Hydroceles in a tropical population, sometimes called tropical hydroceles, are distinguished from those seen in temperate zones by their high prevalence and massive size. Lymphatic obstruction is thought to be the mechanism for development of tropical hydrocele.2 Eradication of the parasite and excision of the hydrocele sac via a scrotal incision is the preferred management.2 In Canada, hydroceles in children are approached through an inguinal incision so that the associated hernia can be controlled, whereas the scrotal approach is primarily used in adults to excise the sac and evert the remnant. Initially, we treated children using the inguinal approach. We then operated on several adults with symptomatic inguinal hernias whose ipsilateral hydroceles had previously been excised via the scrotal approach. We became concerned that adult patients with hydroceles in Haiti had persistence of the processus vaginalis, which had been neglected since childhood. We decided to use the inguinal approach to treat hydroceles in adults if time and resources permitted.