V8-08: Minimal invasive hydrocelectomy technique, ONOL (Outpatient Novel Out Leaf) procedure: 10 years experience
Purpose: 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. Wide and brutal dissection of scrotal structure around hydrocele cause numerous complications, which were mentioned above, in this type of minor surgery. In this study we present our long term results of minimal invasive hydrocelectomy technique with less morbidity.
Between April 2004 and April 2015, 135 patients underwent hydrocelectomy, which was bilateral in 14. Through a 15 mm transverse scrotal incision the tunica vaginalis parietalis was identified and grasped. The sac was dissected bluntly under gentle traction, 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 controlled at 6-month of operation.
Mean operative time was 24.3 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 4 days after surgery (range 1 to 21). Cure was achieved in 130 of the 135 hydrocele cases (96%).
Our pull-through technique enables the surgeon to remove large hydrocele sacs through a tiny hole and with minimal dissection under direct vision of the testicular structures with minimal trauma to the surrounding structures, resulting in early recovery, minimal edema, bleeding and lesser complications. This procedure is an option for the surgical management of idiopathic hydrocele as the evidience by the 10 years experiences.