Surgery Operative Procedures

1. HYDROCOELE
TVT
OPERATIVE SURGERY

2. INTRODUCTION
 A hydrocoele is an abnormal collection of serous
fluid in a part of the processus vaginalis, usually the
tunica vaginalis.
 Acquired hydroceles are primary or idiopathic, or
secondary to epididymal or testicular disease.

3. TYPES OF HYDROCOELE

4. HYDROCOELE TVT SURGERY INDICATIONS
 Scrotal discomfort or pain
 Cosmetic-disfigurement due to the sheer
size of the hydrocele

5. CONTRAINDICATIONS FOR SURGERY
 Secondary hydrocoele due to testicular tumours

6. TYPES OF SURGERY
 LORD’S PLICATION FOR SMALL HYDROCOELES
WITH THIN TVT SAC
 Done under spinal or local anaesthesia.
 Vertical Para median incision is made.
 Layers of scrotum are divided along the line of the
incision.
 Tunica vaginalis sac is identified.
 TVT sac is opened and the hydrocele fluid is drained out.

7. CONTD….
Plicating sutures are placed around the cut opened
tunica vaginalis sac.
Achieve complete haemostasis.
A PVC drain is placed.
Wound is closed in layers.
Scrotal suspensory bandage is given.

9. CONTD….
 JABOULAY’S PROCEDURE FOR LARGE
HYDROCOELES WITH THICK TVT SAC
Vertical Para median incision parallel to the median
raphe of the scrotum is given.
Incision deepened and the hydrocele sac isolated.
Hydrocele fluid drained and excess sac excised.
 Cut edge of Tunica Vaginalis sac is everted and
sutured behind the testis.

10. CONTD…
A PVC drain is placed.
Wound is closed in layers after achieving complete
haemostasis.
Scrotal suspensory bandage is given

12. COMPLICATIONS OF SURGERY
 Injury to vas deferens
 Injury to urethra
 Injury to testis/epididymis
 Reactionary haemorrhage
 Infection
 Sinus formation
 Recurrent hydrocele