Hydrocelectomy

SURGERY PATH

1. HYDROCELECTOMY PROCEDURE TECHNIQUE

2. INTRODUCTION Hydrocele is the most common benign scrotal swelling with estimated incidence as one percent of the adult male population H ydrocele is a common benign disorder that merits surgical correction when symptomatic. The most popular techniques for repair are plication (Lord’s procedure) or excision and eversion of the tunica vaginalis ( Jaboulay procedure). Mihmanli I, Kantarci F, Kulaksizoglu H, Gurses B, Ogut G, Unluer E, et al. Testicular size and vascular resistance before and after hydrocelectomy . AJR Am J Roentgenol . 2004;183:1379-85 .

3. Indication & Contraindication Indication for surgery : Vaginal hydrocele Infantile and funicular hydrocele are also treated surgically in the same manner Contraindication : Secondary hydrocele due to testicular tumors

4. Technique Established complications from these traditional repairs include hematoma, recurrence, and infection. These procedures are performed through a scrotal incision. We describe a novel technique of hydrocele repair with gubernaculum preservation through a subinguinal incision. Mihmanli I, Kantarci F, Kulaksizoglu H, Gurses B, Ogut G, Unluer E, et al. Testicular size and vascular resistance before and after hydrocelectomy . AJR Am J Roentgenol . 2004;183:1379-85 .

5. N ovel T echnique A 2–3 cm incision is made over the subinguinal spermatic cord Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

6. N ovel T echnique S permatic cord is isolated and elevated in the wound. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

7. N ovel T echnique Gentle pressure on the scrotum mobilizes the hydrocele sac into the wound. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

8. N ovel T echnique The tunica vaginalis is opened anteriorly while maintaining preservation of the gubernacular attachments. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

9. N ovel T echnique A single figure-of-eight suture approximates the everted tunica vaginalis posterior to the spermatic cord and testis. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

10. N ovel T echnique Gentle traction on the scrotum pulls the testis back into orthotopic position. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

11. Results at the three-week postoperative visit. Neal E. Rowe , et al. The Western snip, stitch, and tug hydrocelectomy : How I do it . Can Urol Assoc J . 2016 Sep-Oct; 10(9-10): E328–E330.

12. Technique Hydrocelectomy through eversion procedures for hydrocele may cause postoperative discomfort, temporary limitation of normal activities and complications, such as hematoma, infection, persistent swelling, chronic pain and decreased fertility so we will published new minimally access hydrocelectomy Aly Saber . Minimally access versus conventional hydrocelectomy : a randomized trial. Department of General Surgery, Port- Fouad general Hospital, Port- Fouad , Egypt . IBJU Vol . 41 (4): 750-756, July - August, 2015

13. New Minimally Access Hydrocelectomy A small scrotal incision 2cm long was done and incision of the Dartos muscles in the same line was done with electrocautery Figure 1A - An operative photograph showing the length of the scrotal skin incision, 2cm (it appears longer due to stretch of the skin by the assistant).

14. New Minimally Access Hydrocelectomy A small scrotal incision 2cm long was done and incision of the Dartos muscles in the same line was done with electrocautery Figure 1B - An operative photograph showing delivery of the hydrocele sac through the small scrotal skin.

15. New Minimally Access Hydrocelectomy The parietal tunica vaginalis (PTV) was grasped and minimal blunt dissection was made by the aid of the index finger and a small hole was made for aspiration of hydrocele fluid Figure 2A - An operative photograph showing evacuation of hydrocele fluid through a small hole made in the tunica vaginalis .

16. New Minimally Access Hydrocelectomy Then a disc of tissue was excised of the PTV about double of the skin incision dimension using electrocautery. The edge of the visceral surface tunica vaginalis was sutured to the parietal layer of the tunica vaginalis and then to the Dartos Figure 2B - An operative photograph showing in situ excision of the hydrocele sac using electrocautery .

17. New Minimally Access Hydrocelectomy Then all were sutured to scrotal skin in an everted manner aiming to expose the visceral tunica toward scrotal skin Figure 3A - An operative photograph showing the beginning of the eversion technique. Blue arrow points to the visceral tunica vaginalis while the black one points to the parietal tunica.

18. New Minimally Access Hydrocelectomy Then all were sutured to scrotal skin in an everted manner aiming to expose the visceral tunica toward scrotal skin Figure 3B - An operative photograph showing completed eversion technique by suturing of the edge of the tunica to the Dartos and scrotal skin in an everted manner aiming to expose the visceral tunica toward scrotal skin.

19. J aboulay’s Technique Incision : Hydrocele is held tense by an assistant and 5-6 cm incision <depending upon size > is made over the most prominent part of the swelling parallel to the median raphe of the scrotum Layers opened :skin, dartos , external spermatic fascia , cremasteric fascia , internal spermatic fascia at this stage hydrocele sac is visible and is delivered outside the incision • Hydrocele fluid is drained by using trocar and cannula An opening is made in the tunica vaginalis sac and it is enlarged ,all fluid is drained out. Testis and epididymis are inspected for any pathology Fatih Ozkaya et al. Jaboulay’s technique contrasted with a novel hydrocelectomy technique using a vessel sealer in the treatment of adult hydrocele: a prospective randomized study. In International Urology and Nephrology. 2019 https :// doi.org/10.1007/s11255-019-02342-8

20. J aboulay’s Technique Partial excision and eversion of sac is ideal treatment .In this operation ,after excision of the sac ,cut edge of the sac is everted and sutured behind the testis . Fatih Ozkaya et al. Jaboulay’s technique contrasted with a novel hydrocelectomy technique using a vessel sealer in the treatment of adult hydrocele: a prospective randomized study. In International Urology and Nephrology. 2019 https :// doi.org/10.1007/s11255-019-02342-8

21. J aboulay’s Technique Closure : a corrugated plastic drain is kept in the scrotum and brought out separately by making a stab incision and is anchored to the scrotal skin by white thread – Subcutaneous layer by using 2-0 chromic catgut Skin : interrupted thread(white)/catgut .absorbable sutures such as catgut or vicryl can also be used - Scrotal support is given to reduce oedema Fatih Ozkaya et al. Jaboulay’s technique contrasted with a novel hydrocelectomy technique using a vessel sealer in the treatment of adult hydrocele: a prospective randomized study. In International Urology and Nephrology. 2019 https :// doi.org/10.1007/s11255-019-02342-8

22. J aboulay’s Technique Surgical steps of sac excision: a inspection of hydrocele, b opening scrotum, c – f excision of sac, g after sac excision, h fixation of the testicle to scrotum, and i , j fixed testicle and final view of scrotum

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