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Prof. Dr. Ali Avanoğlu
Undescended Testicle • After surgery

Undescended Testicle and Inguinal Hernia

An inguinal hernia occurs when an extension of the abdominal lining remains open in the inguinal canal and bowel or fluid enters it. In most children with an undescended testicle, this sac has remained open and is closed through the same incision during orchiopexy (fixing the testicle in the scrotum). This page explains the hernia's relationship to undescended testicle, its repair in the same session, and what to do if groin swelling appears after surgery.

Who this is forFamilies who notice swelling in the groin or scrotum that comes and goes
Reading≈5 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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in the inguinal canal
01 · Why do undescended testicle and hernia occur together?02 · What is done during surgery?03 · Hernia before surgery: when is it an emergency?04 · Groin swelling after surgery05 · Who treats it?
In brief5 madde
  • Why do undescended testicle and hernia occur together?: As the testicle descends into the scrotum in the womb, an extension of the abdominal lining (the processus vaginalis) descends with it; once descent is complete, this…
  • What is done during surgery?: In inguinal (groin-approach) orchiopexy, as the testicle and cord structures are mobilized, the open sac is separated from the cord and closed by ligation at the…
  • Hernia before surgery: when is it an emergency?: If swelling is noticed in the groin or scrotum of a child awaiting surgery, it should be reported to the doctor; a significant hernia may require moving the…
  • Groin swelling after surgery: Soft swelling in the groin and scrotum is expected in the first weeks after orchiopexy; this is swelling and a small amount of blood collection, and it subsides…
  • Who treats it?: Undescended testicle and hernia are addressed by the same team in the same session; having two pediatric urologists operate together provides extra safety when…
01

Why do undescended testicle and hernia occur together?

As the testicle descends into the scrotum in the womb, an extension of the abdominal lining (the processus vaginalis) descends with it; once descent is complete, this extension normally closes. When the testicle does not descend, this closure is usually also incomplete.

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  • If the open sac is thin and empty, the family won't notice it; if the sac is wide, bowel or fluid from the abdomen can enter it and appear as swelling in the groin or scrotum that comes and goes. A fluid-filled sac is called a hydrocele, and one that bowel enters is called a hernia.
  • The literature reports that most children with an undescended testicle are found to have an open sac at surgery; however, only some of them show hernia symptoms before surgery. This is why, even if no hernia is seen before surgery, families are told from the start that the sac will be found and closed.
  • An open sac can also be seen in ectopic testicle and ascending testicle cases; in a retractile testicle, the sac has usually closed. Observing the groin during straining and crying on examination helps support this distinction.
02

What is done during surgery?

In inguinal (groin-approach) orchiopexy, as the testicle and cord structures are mobilized, the open sac is separated from the cord and closed by ligation at the level of the internal ring; a separate hernia operation is not needed.

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  • Separating the sac from the cord is also one of the most important steps in allowing the testicle to reach the scrotum tension-free; this is why hernia repair is an integral part of orchiopexy.
  • In scrotal orchiopexy, done through a single incision in the scrotum, the sac is also checked; if there is a significant hernia, it may be necessary to switch to a groin incision, and this possibility is discussed beforehand. In laparoscopic orchiopexy, the internal ring is viewed from inside the abdomen and closed in the same session if needed.
03

Hernia before surgery: when is it an emergency?

If swelling is noticed in the groin or scrotum of a child awaiting surgery, it should be reported to the doctor; a significant hernia may require moving the orchiopexy up sooner.

  • If the swelling appears with crying and straining and disappears when the child is calm: inform your doctor, and the plan will be reviewed.
  • If the swelling is hard, painful, red, and cannot be pushed back in: go to the emergency room.
  • If accompanied by vomiting, abdominal distension, and constant distress: go to the emergency room.
  • The most important risk of a hernia is bowel becoming trapped in the sac (incarceration). In this situation, the swelling is hard and painful, cannot be pushed back in by hand, the child is distressed, and vomiting may occur. Trapped bowel can also press on the testicle's blood vessels. This is an emergency and must be evaluated without delay.
04

Groin swelling after surgery

Soft swelling in the groin and scrotum is expected in the first weeks after orchiopexy; this is swelling and a small amount of blood collection, and it subsides within a few weeks.

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  • A new hernia developing (recurrence) is rare; when the sac is properly closed, the literature reports very low recurrence rates. New swelling that appears weeks after surgery, enlarges with straining, and disappears when lying down is evaluated for hernia recurrence or hydrocele.
  • A postoperative hydrocele — fluid buildup in the scrotum — is seen from time to time and mostly resolves on its own within months; if it persists, it is corrected with a minor procedure. The distinction is made on examination; ultrasound can help if needed, since the goal here is to see the content of a palpable structure.
05

Who treats it?

Undescended testicle and hernia are addressed by the same team in the same session; having two pediatric urologists operate together provides extra safety when separating the sac from the cord structures.

  • Follow-up afterward continues with the same team; groin swelling that appears during adolescence or adulthood is also evaluated together with adult urology.
Undescended Testicle video guide15 short videos, in order
Frequently asked questions
Is a separate operation needed for the hernia?
No. During undescended testicle surgery, the open sac is closed through the same incision; this is a standard step of orchiopexy. A separate hernia operation only comes up in the rare case of recurrence.
The testicle is in the scrotum, but there's swelling in the groin — is that a hernia too?
It can be; an open sac can remain even in children whose testicle has descended. Swelling that comes and goes and enlarges with straining suggests a hernia or hydrocele. The two are distinguished on examination; a hydrocele mostly closes on its own during infancy, while a hernia is repaired surgically.
Can a hernia go away on its own?
A hernia containing bowel does not close on its own; it requires repair. A hydrocele that contains only fluid mostly resolves on its own within the first 1–2 years of age. Examination determines which one it is.
There's a firm lump palpable in the groin after surgery — is it a hernia?
Firmness palpable beneath the incision in the first weeks is related to healing tissue and dissolving stitches; it softens over time. Firmness that is painless, stable, or shrinking is not a problem; swelling that grows, changes with straining, or is painful should be evaluated.
What is the condition commonly called a 'testicle hernia'?
What is commonly referred to as a 'testicle hernia' is, in medical terms, an inguinal hernia: the failure of the abdominal lining sac that descends with the testicle to close, and the entry of bowel or fluid into it. It presents as soft swelling in the groin or scrotum that becomes more noticeable with crying, straining, and standing, and disappears when lying down. If the swelling becomes hard, painful, and cannot be pushed back in, the bowel may be trapped; this is an emergency and requires going to the nearest emergency room without delay.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Ulman I, Demircan M, Arikan A, et al. (1995). Unilateral inguinal hernia in girls: is routine contralateral exploration justified? Journal of pediatric surgery. PubMed ↗
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Related pagesFull index →
Surgery in childrenUndescended Testicle in the Groin: Inguinal OrchiopexyAn undescended testicle palpable in the groin accounts for the large majority of cases and is the group with the most predictable treatment. Inguinal (groin) orchiopexy is the standard approach for this testicle: the testicle is freed through a small groin incision, the hernia sac is closed, and the testicle is fixed in the scrotum.After surgeryPostoperative CareOrchiopexy (fixing the testicle in the scrotum) is usually outpatient surgery, and the child goes home the same day. Knowing what to expect during the first days at home helps reassure the child and makes it easier to recognize the signs that truly matter. This page walks through the process step by step, from returning home to the first follow-up visit.After surgeryPostoperative PainSome pain is expected after orchiopexy (fixing the testicle in the scrotum) and is controlled with simple pain medication. What matters is being able to tell apart pain that is a natural part of healing from pain that signals a problem. This page explains the expected course of pain, how to manage it, and the warning signs that need urgent attention.Surgery in childrenWhat Is Orchiopexy?Orchiopexy is the umbrella term for undescended testicle surgery: the testicle and its blood vessels are freed from surrounding tissue, brought down into the scrotum without tension, and fixed in place there. The surgical approach and number of stages may vary, but the backbone of the operation is the same.
Undescended Testicle topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Surgery in children 10Special situations 4After surgery 6Adolescents and adults 6Follow-up 3
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