Laparoscopic Management of Pediatric Noncommunicating Hydrocele: A Comparative Study of Hydrocelectomy Versus Aspiration

Background: Pediatric noncommunicating hydrocele (NCH) requires surgical treatment when spontaneous resolution does not occur. Although communicating hydrocele is typically treated with high ligation alone, NCH traditionally requires hydrocelectomy with high ligation. Evidence comparing laparoscopic hydrocelectomy and simple aspiration in children remains limited. Methods: We retrospectively analyzed 2500 children under 10 years who underwent laparoscopic management for NCH between 2016 and 2024. Patients were categorized into scrotal hydrocele (SH) and encysted spermatic cord hydrocele (ESCH), and surgical methods were classified as hydrocelectomy or aspiration, both combined with high ligation. Operative outcomes and recurrence were compared between subtypes and surgical techniques. Results: Among 2500 patients (SH: 862; ESCH: 1638), ESCH had a significantly higher association with inguinal hernia (13.6% versus 9.2%; P < .001). Most patients underwent hydrocelectomy ( n = 2449, 98%), while 51 (2%) underwent aspiration. Recurrence was markedly higher after aspiration than hydrocelectomy (5.9% versus 0.3%, P < .001). Complications were infrequent and comparable between groups. Conclusion: Laparoscopic hydrocelectomy with high ligation is a highly effective and safe treatment for pediatric NCH, with an exceptionally low recurrence rate. Aspiration showed inferior and inconsistent outcomes, suggesting that it should be reserved for very select cases. These findings support complete laparoscopic hydrocelectomy as the preferred minimally invasive technique for pediatric NCH.