I certainly recommend surgery - if he is healthy enough that you don't think that surgery may pose a great risk. I had surgery for my hydrocele, and it was relatively painless. I am veryyyy glad I did it. But I am a lot younger. It isn't an overly long procedure, and the effects of the anesthesia were relatively mild. I have had surgery before where it took days to recover from - and I felt like i had been run over by a bus - but in my case for the hydrocele, it wasn't like this. My hydrocele became the size of a tangerine, and it wasn't something I wanted. Although at least in the case of a hydrocele, which may be slightly different from a hemocele, I was told it posed no health risks. But still. You never know.