A Novel Pull-Through Technique for the Surgical Management of Idiopathic Hydrocele

Abstract

Standard surgical 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. We describe a new technique in an effort to decrease these complications. Between April 2004 and December 2006, 21 patients underwent hydrocelectomy, which was bilateral in 1. Through a 15 mm transverse scrotal incision the tunica vaginalis parietalis was identified and grasped. Under gentle traction the sac was dissected bluntly and delivered out of the incision. The fully mobilized tunica was excised by electrocautery at its base, followed by wound closure. Patients were discharged home within 24 hours after surgery and were followed at 6-month intervals for a minimum of 18 months. Mean operative time was 27.3 minutes. Postoperatively hematoma or wound infection was not evident in any case. Mild scrotal edema usually subsided within a few days after the procedure. Two patients with persistent edema and hardening of the scrotum required additional bed rest and anti-inflammatory agents. Patients were able to resume normal daily activity an average of 6 days after surgery (range 3 to 21). Cure was achieved in 21 of the 22 hydrocele cases (95%). Our pull-through technique enables the surgeon to remove large hydrocele sacs through a small incision and with minimal dissection under direct vision of the testicular structures, resulting in early recovery and minimal complications. This procedure may be a viable option for the surgical management of idiopathic hydrocele.