Efficacy of Tunica Vaginalis Eversion during open Varicocelectomy to Minimize Postoperative Hydrocele Versus No Eversion
Mohamed Aly Elhorbity, and Ehab Shehata Abdullah
Background: A varicocele is an atypical enlargement and dilatation of the scrotal venous pampiniform
plexus, which is responsible for the drainage of blood from each testicle. Although varicoceles are
typically asymptomatic, they possess clinical significance due to their high prevalence, which results in
anomalous semen analysis, diminished sperm motility, low sperm count, and atypical sperm morphology.
Initially, analgesics and scrotal support may be applied to alleviate pain or distress associated with
a varicocele. Additionally, it is well-established that varicocele surgery results in the restoration of
testicular volumes and semen parameters. The purpose of this study is to compare the outcomes of open
varicocelectomy with and without eversion of tunica vaginalis in relation to scrotal oedema, wound
infection, postoperative pain, and postoperative hydrocele.
Methods: From October 2017 to October 2021, sixty patients between the ages of 18 and 40 who presented
with grade IV or V varicocele participated in this study. The patients were divided into two groups, with
30 patients in each: group A underwent open varicocelectomy with tunica vaginalis eversion; and group
B underwent open varicocelectomy without tunica vaginalis eversion. The documented complications
of the two groups were contrasted. The duration of the operation, the need for postoperative analgesics,
the length of hospitalization, the improvement in semen characteristics of subfertile participants, pain
assessed using a visual analog scale, and postoperative complications between the two groups were
recorded and compared.
Results: There was no significant difference in postoperative pain between groups A and B, as measured
by a numeric analog scale ranging from 1 to 3 after one and two weeks and from number 2 to 5 in
the initial three days. In group A, the duration of the operation varied between 40 and 60 minutes for
unilateral cases and 60 to 80 minutes for bilateral cases. In contrast, the duration of the operation
varied between 30 and 50 minutes for unilateral cases and 70 to 90 minutes for bilateral cases in group
B. In seven patients in group A and three patients in group B, mild scrotal edema resolved within one
to three weeks after the procedure. Infection of the lesion was absent in both groups. Similar hospital
stays spanning one to three days were observed in both cohorts. A case of mild scrotal hematoma
was identified in each cohort; it was treated conservatively without any complications. Postoperative
monitoring for hydrocele is conducted for duration of six months in both cohorts. A solitary instance of
minimal hydrocele was identified in group A, while four instances of moderate hydrocele were detected
in group B. In addition, two cases of moderate hydrocele in group B necessitated surgical intervention
due to persistent scrotal pain and symptomatic edema, while the remaining two cases were treated
conservatively with follow-up and did not present with pain.
Conclusion: In hospitals that perform open varicocelectomy without access to an operating microscope,
the eversion of the tunica vaginalis during open varicocelectomy is considered a preventative measure
that decreases the incidence of postoperative hydrocele when compared with no eversion, according to
the findings of the present study.
