Mini Hydrocelectomy – Outcome of A Short Term Study and Comparison with Conventional Jaboulays Technique
Background: Hydrocele is among the commonest benign conditions of scrotum. Its incidence is around 1% in adult male population with a predilection for males above 40 years of age. Conventional surgical procedures like Jaboulays Eversion of Sac (EOS) and Lords plication of redundant tunica vaginalis remain the most commonly used procedures used in the treatment of idiopathic adult hydrocele. Both procedures are invasive and are associated with durable success and low incidence of recurrence. These procedures are however associated with many post-operative complications like pain, hematoma, infection, persistent swelling and induration of scrotal skin, wound related complications, chronic pain and reduced fertility. All these translate into high morbidity, loss of work hours and increased surgical expenses. To avoid / minimize these complications associated with plication or excision of the redundant hydrocele sac fenestration has been proposed as a minimal access procedure. Fenestration exposes the secretory surface of the tunica vaginalis sac to the lymphatic-rich subcutaneous tissues, from where the hydrocele fluid is cleared off the scrotal cavity. Methods: The present study was carried out in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard during the time period of June 2014 - December 2015. 120 patients of primary vaginal type hydrocele with ASA grade 1 were randomly allocated into two groups of 60 patients each – one group for the Mini-Hydroceletomy MiH-(Group A) and the other group for routine Jaboulays EOS (Group B). All the patients were followed up for a period ranging from 6-18 months. Results: Mean age of patients was 42 years for jabouleys and 45 for mini hydrocelectomy group. Mean hydrocele volume for Group A was 240 ml and for group B was 252 ml. Average time for the procedure in group A was 10-12 min (mean 11min) and for group B was 25 -30min (mean 27min). In Group A, Average incision length was 2.1 cm whereas in Group B it was 5.4 cm. Conclusions: We hereby present our experience that mini-hydrocelectomy (MiH) technique to be the procedure of choice for medium sized uncomplicated hydroceles.
2. Mihmanli I, Kantarci F. Sonography of scrotal abnormalities in adults: An update. Diagn Interv Radiol. 2009;1:64-73.
3. Erdas E, Pisano G, Pomata M, et al. Sclerotherapy and hydrocelectomy for the management of hydrocele in outpatient and day- surgery setting. Chir Ital. 2006;58:619-25.
4. Agbakwuru EA, Salako AA, Olajide AO, et al. Hydrocelectomy under local anaesthesia in a Nigerian adult population. Afr Health Sci. 2008;8:160-62.
5. Kiddoo DA, Wollin TA, Mador DR. A population based assessment of complications following outpatient hydrocelectomy and spermatocelectomy. J Urol. 2004;171(2 Pt. 1):746-48.
6. Onol SY, Ilbey YO, Onol FF, et al. A novel pull-through technique for the surgical management of idiopathic hydrocele. J Urol. 2009;181:1201-05.
7. Tariel E, Mongiat-Artus P. Treatment of adult hydrocele. Ann Urol. 2004;38:180-85.
8. Chalasani V, Woo HH. Why not use a small incision to treat large hydroceles? ANZ J Surg. 2002;72:594-95.
9. Khaniya S, Agrawal CS, Koirala R, et al. Comparison of aspiration- sclerotherapy with hydrocelectomy in the management of hydrocele: A prospective randomized study. Int J Surg. 2009;7:39239.
10. Beiko DT, Kim D, Morales A. Aspiration and sclerotherapy versus hydrocelectomy for treatment of hydroceles. Urology. 2003;61:708-12.
11. Darzi A, Mackay S. Recent advances in minimal access surgery. BMJ. 2002;5:31-34.
12. Georgeson KE, Owings E. Advances in minimally invasive surgery in children. Am J Surg. 2000;180:362-364.
13. Swartz MA, Morgan TM, Krieger JN. Complications of scrotal surgery for benign conditions. Urology. 2007;69:616-619.
14. Kim JK, Shin JH, Lim JS. 10-Year retrospective study of the operative treatment results of adult type hydrocele. Korean J Urol. 2008;49:82-87.
15. Ross LS, Flom LS. Azoospermia: A complication of hydrocele repair in a fertile population. J Urol. 1991;146:852-853.
16. Shan CJ, Lucon AM, Arap S. Comparative study of sclerotherapy with phenol and surgical treatment for hydrocele. J Urol. 2003;169: 1056-1059.
17. Saber A. New minimally access hydrocelectomy. Urology 2011 Feb;77(2):487-90.
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