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Hydrocelectomy: Surgical Technique and Complications

Indications for Hydrocelectomy

Disturbing size or pain due to a hydrocele is an indication for hydrocelectomy, see section hydroceles.

Hydrocelectomy with resection of the hydrocele sac. A) Resection of the hydrocele sac B) The hydrocele sac is oversewn for hemostasis (von Bergmann technique) C) The hydrocele sac edges are sewn together behind the spermatic cord (Winkelmann or Jaboulay technique)

Lord technique of hydrocele surgery: the hydrocele sac is reduced by plication sutures.

Contraindications

Elective indication: coagulation disorders, any disease with an increased risk for surgery.

Surgical Techniques of Hydrocele Operations

Preoperative Patient Preparation

• Patient positioning: supine position
• General, spinal or local anesthesia
• Perioperative antibiotic prophylaxis

Surgical Approach for Hydrocelectomy:

Inguinal exposure is necessary for open processus vaginalis, hydrocele of the spermatic cord, or if a testicular tumor is suspected. Scrotal exposure is done for hydrocele testis.

Hydrocelectomy with Excision of the Hydrocele Sac:

Incision of the hydrocele sac after complete mobilization of the hydrocele. Partial resection of the hydrocele sac, leaving a margin of 1–2 cm. Care is taken not to injure testicular vessels, epididymis, or ductus deferens. The edge of the hydrocele sac is oversewn for hemostasis (von Bergmann's technique), or the edges are sewn together behind the spermatic cord (Winkelmann's or Jaboulay's technique). Hydrocele surgery with excision of the hydrocele sac is useful for large or thick-walled hydroceles and multilocular hydroceles; see also the following figures:

Hydrocele Surgery with Plication of the Hydrocele Sac:

The hydrocele is opened with a small skin incision without further dissection. The hydrocele sac is reduced (plicated) by suture Hydrocele surgery: Lord technique. The plication technique is suitable for medium-sized and thin-walled hydroceles. The advantage of the plication technique is the minimized dissection with a reduced complication rate (Tsai et al., 2019).

Postoperative Care

Pain medication, pressure dressing (and drain) for 1–2 days, avoid physical activity, bed rest and elevate scrotum, regular wound examination.

Complications of Hydrocelectomy

Bleeding, infection. Recurrence of the hydrocele after hydrocelectomy is below 5%. Damage to the epididymis or vas deferens with infertility. Testicular loss due to complications is rarely possible.

References

Ku u.a. 2001 KU, J. H. ; KIM, M. E. ; LEE, N. K. ; PARK, Y. H.: The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele.
In: BJU Int
87 (2001), Nr. 1, S. 82–4

L. Tsai, P. A. Milburn, C. L. Cecil, P. S. Lowry, and M. R. Hermans, “Comparison of Recurrence and Postoperative Complications Between 3 Different Techniques for Surgical Repair of Idiopathic Hydrocele.,” Urology, vol. 125, pp. 239–242, 2019.

  Deutsche Version: Operationen der Hydrozele