Minimally access versus conventional hydrocelectomy: a randomized trial

Abstract

Objective: To compare our previously published new minimally access hydrocelectomy versus Jaboulay's procedure regarding operative outcome and patient's satisfaction.

Materials and methods: A total of 124 adult patients were divided into two groups: A and B. Group A patients were subjected to conventional surgical hydrocelectomy (Jaboulay's procedure) and group B patients were subjected to the new minimal access hydrocelectomy. The primary endpoint of the study was recurrence defined as a clinically detectable characteristic swelling in the scrotum and diagnosed by the two surgeons and confirmed by ultrasound imaging study. The secondary endpoints were postoperative hematoma, wound sepsis and persistent edema and hardening.

Results: The mean operative time in group B was 15.1 ± 4.24 minutes and in group A was 32.5 ± 4.76 minutes (P ≤ 0.02). The mean time to return to work was 8.5 ± 2.1 (7-10) days in group B while in group A was 12.5 ± 3.53 (10-15) days (P=0.0001). The overall complication rate in group B was 12.88% and in group A was 37%. The parameters of the study were postoperative hematoma, degree of scrotal edema, wound infection, patients' satisfaction and recurrence.

Conclusion: Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient's satisfaction when compared to conventional eversion-excision hydrocelectomies.

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).

Figure 1B. An operative photograph showing delivery of the hydrocele sac through the small scrotal skin.

Figure 2A. An operative photograph showing evacuation of hydrocele fluid through a small hole made in the tunica vaginalis.

Figure 2B. An operative photograph showing in situ excision of the hydrocele sac using electrocautery.

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.

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.