Excellent results are possible with surgical excision of the hydrocele sac.
Treatment depends upon the age of the patient and the degree of discomfort caused by the hydrocele. Surgical excision forms the definitive therapy for hydroceles. Most hydroceles are on both sides and surgery is usually undertaken for both the sides simultaneously.
When they are small and asymptomatic, hydroceles require no treatment other than reassurance. Indications
for surgery includes -
• Scrotal discomfort or pain
• Cosmetic - disfigurement due to the sheer size of the hydrocele.
Principle of surgical excision
Two techniques are effective treatments for hydroceles.
The first technique, plication of the sac (Lord’s procedure)
is used for small to medium hydroceles. The benefits of this technique are reduced risk of hematoma (localized collection of blood). Some articles suggest a slight incidence of recurrence of the hydrocele following this procedure. The second technique, where the sac is everted and sutured behind the testis (Jaboulay procedure)
, is associated with a reduced risk of recurrence, but patients may have an increased risk of hematoma.
During surgery, the bulk of the hydrocele sac is cut away, and what remains of the sac is turned inside out. As a result, the fluid-secreting surface is now in contact with the inner skin of the scrotum rather than that of the testicle with which it made previous contact. The scrotal tissue blots up any fluid that is secreted, unlike the testicular tissue that cannot absorb fluid.
Surgical approaches are governed by 1) the size of the hydrocele and 2) the experience and preference of the surgeon.